Vancomycin-resistant enterococci, colonizing the intestinal tract of patients in a university hospital in greece

Metallidis, Simeon; Chatzidimitriou, Maria; Tsona, Afroditi; Bisiklis, A.; Lazaraki, Georgia; Koumentaki, Eleni; Gikas, Achilleas; Alexiou-Daniel, S.; Nikolaidis, Pavlos

doi:10.1590/s1413-86702006000300005

Cited by 19 publications

(11 citation statements)

References 34 publications

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“…The most prevalent species, with 86.9 % in hospitalized patients, was E. faecium , against the prevalence of vancomycin resistant E. gallinarum and vancomycin resistant E. fecalis with 8.69 % and 4.34 %, respectively (p < 0.05). These data agree with those found in the literature [ 15 , 16 ]. Analyzing the genotypes in VRE, we found that the most prevalent genotype was vanA (80.4 %), against vanB and vanC genotypes, present in 7.8 % and 11.8 % of VRE isolates, respectively.…”

Section: Discussionsupporting

confidence: 93%

Gastrointestinal Colonization with Vancomycin-Resistant Enterococci in Hospitalized and Outpatients

Trajkovska-Dokic

Kaftandzieva

Stojkovska

et al. 2014

Open Access Maced J Med Sci

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BACKGROUND:The incidence of infection and intestinal colonization with vancomycin resistant enterococci (VRE) is increasing in many countries in the last decade. Concerning the difficult antimicrobial treatment of infections caused by VRE, decreasing the incidence and prevalence of these infections is an important factor in VRE-induced morbidity and mortality control.AIM:To determine the prevalence of gastrointestinal colonization with vancomycin resistant enterococci in hospitalized and outpatients, and to determine the genetic base of the vancomycin resistance in VRE isolates.MATERIAL AND METHODS:Seven hundred and eighty stool specimens were investigated for the gastrointestinal carriage of vancomycin-resistant enterococci (VRE). Susceptibility to vancomycin was tested in all isolates by disk-diffusion test and E-test (AB Biodisk, Sweden). Determined vancomycin resistant enterococci were than tested for detection of vanA, vanB and vanC genes by PCR.RESULTS:Vancomycin resistant strains of enterococci were isolated from 46 (16.1 %) of the 285 hospitalized patients and 5 (7.7 %) of the 65 patients living in the community (p < 0.05). The most of the highly resistant enterococci strains to vancomycin (95.2 %), were identified as E. faecium. Minimal inhibitory concentrations (MICs) to vancomycin in all 39 vanA genotypes of E. faecium and two vanA genotypes of E. fecalis were > 256 μg/ml. Three vanB genotypes of E. faecium and one vanB genotype of E. faecalis had MICs of 32 μg/ml. All six vanC genotypes of E. gallinarum had MICs of 8 μg/ml. All vanA genotypes of VRE were highly resistant to vancomycin, with MICs above 256 μg/ml. Three vanB genotypes of VR E. faecium and one VR E. fecalis were resistant, with MICs 32 μg/ml. vanC genotypes of VR E. gallinarum were intermediate resistant to vancomycin with MICs of 8 μg/ml.CONCLUSIONS:The prevalence of vancomycin resistant enterococci in Republic of Macedonia was 2-fold higher in hospitalized than in outpatients. VanA genotype was dominant in isolates of E. faecium and it was highly associated with the MIC values above the 256 μg/ml. Since most of the enterococcal infections are endogenous, there is a need for screening the colonization of patient’s intestinal flora with VRE at the hospital entry. Identification and genotyping of faecal enterococci, together with their susceptibility testing to vancomycin, could be useful marker for the infection control.

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Section: Discussionsupporting

confidence: 93%

Gastrointestinal Colonization with Vancomycin-Resistant Enterococci in Hospitalized and Outpatients

Trajkovska-Dokic

Kaftandzieva

Stojkovska

et al. 2014

Open Access Maced J Med Sci

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“…While Greece is considered one of the most common countries in Europe for antimicrobial resistance (6), only a limited number of studies have focused on MDRO rectal carriage and colonization to assess their prevalence, risk factors, and associated adverse outcomes (7)(8)(9)(10)(11). A previous study from our hospital has reported a prevalence of 14.3% of VRE carriage among hospitalized patients, identified invasive devices and duration of antimicrobial treatment as risk factors, and found that VRE carriage was not an independent predictor of mortality (12).…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal Carriage of Vancomycin-Resistant Enterococci and Carbapenem-Resistant Gram-Negative Bacteria in an Endemic Setting: Prevalence, Risk Factors, and Outcomes

Vasilakopoulou

Karakosta

Vourli

et al. 2020

Front. Public Health

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Background: Gastrointestinal carriage of vancomycin-resistant enterococci (VRE) and carbapenem-resistant Gram-negative bacteria (CRGN) constitutes a major public health concern as it may be followed by clinical infection development or lead to intra-hospital dissemination. Detection of carriers and implementation of infection control measures are essential in every hospital. In this study we determined the point prevalence of VRE and CRGN in the fecal flora of the inpatients of a tertiary university hospital in Greece. We determined risk factors for carriage and examined the impact of carriage on hospital outcomes. Materials/Methods: A point prevalence study of VRE/CRGN rectal carriage of inpatients was conducted on March 2018. Specimens were selectively cultured for VRE/CRGN, microorganisms were biochemically identified, submitted to antibiotic susceptibility testing, and tested for carbapenemase production. Data on potential risk factors and hospital outcomes were collected at the time of culture and until hospital discharge. Multivariable logistic and linear regression models were used, adjusting for confounders.Results: Four hundred ninety-one patients were enrolled in the study. Of them, 64 (13.0%) were positive for VRE carriage, 40 (8.2%) for CRGN, and 10 patients (2.1%) for both VRE and CRGN. VRE carriage was independently associated with age over 65 years (adjusted OR: 2.4 [95%CI: 1.3, 4.5]) and length of stay (LOS) before rectal sampling (OR: 1.1 [95%CI: 1.0, 1.1]). Carriage of CRGN was associated with 11 days increase of LOS after rectal sampling (β-coef: 11.4 [95%CI: 1.6, 21.2]), with a 3.5-fold increased risk of acquiring a resistant pathogen after rectal swabbing (RR: 3.5 [95%CI 1.2, 9.9]) and with a 6-fold increased risk of mortality (RR: 6.1 [95%CI: 2.1, 17.9]), after adjusting for sex, age, and comorbidity index. Vasilakopoulou et al. Gastrointestinal Carriage: Prevalence, Risk-Factors, Outcomes Conclusions: High prevalence rates were found for VRE and CRGN carriage among the inpatients of our hospital. Prolonged hospitalization and age were independent risk factors for VRE carriage, while CRGN carriage was associated with increased risk of acquiring a resistant pathogen, prolonged hospital stay, and increased mortality.

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“…Broad-spectrum antibiotic therapy reduces the anaerobic flora, and causes enterococci to gain pathogenic features [1][2][3]. Colonization of VRE is facilitated with drug combinations such as third generation cephalosporins, gentamycin, and ciprofloxacin with ampicillin due to significant activity against gut anaerobes [9]. In our patients with and without the history of maternal antibiotic usage, average days of the VRE colonization detection are 13 days and 12 days, respectively.…”

Section: Discussionmentioning

confidence: 80%

“…While they cause urinary infections and intraabdominal infections in healthy persons [1][2][3]. They also cause more invasive infections such as bacteremia and sepsis [1,3], ventriculitis [4], endocarditis [5], infected thrombus [6] and necrotizing enterocolitis (NEC) [7,8] in immune suppressive patients and neonates [9,10]. Enterococci often are resistant to many antibiotics, and they can carry the gene of the glycopeptide resistance, which can also be transferred to other bacteria [2,11,12].…”

Section: Introductionmentioning

confidence: 99%

Vancomycin Resistant Enterococci outbreak in neonatal unit and management of cases after discharge

Akın

Güneş

Perçin

et al. 2015

J Pediatr Infect Dis

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Today, hospital infections with vancomycin resistant enterococci (VRE) in neonatal units have been seen with increasing frequency in recent yr. However, VRE colonized persons have greater risks for public health after discharge. We evaluated the risk factors in the prenatal and natal period of patients with VRE colonization and/or infection, as well as measures taken during VRE outbreak and after discharge occurring between the mo of February to April of 2009 in the Erciyes University, Neonatology Unit. VRE colonization and/or infection was detected in 26 (5.9%) of the 438 patients during time of outbreak. Enterococcus faecium was isolated in rectal swab cultures of all patients, and the type of glycopeptide resistance was VanA in all patients except one. Three of cases were term (11%), the remaining 23(89%) were preterm. E. faecium isolated from the blood culture in two patients. The history of mothers including prenatal risk factors and infant related risk factors were evaluated. The number of cases with VRE-positive was 15 (57%) on discharge and three of these patients were still colonized with VRE at re-hospitalization. The outbreak of VRE, experienced in our unit usually occurs in the manner of colonization. Prevention of colonization require reduction of the use of antibiotics in the perinatology and neonatology units, infection control measurements to be maximized.

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Vancomycin-resistant enterococci, colonizing the intestinal tract of patients in a university hospital in greece

Cited by 19 publications

References 34 publications

Gastrointestinal Colonization with Vancomycin-Resistant Enterococci in Hospitalized and Outpatients

Gastrointestinal Colonization with Vancomycin-Resistant Enterococci in Hospitalized and Outpatients

Gastrointestinal Carriage of Vancomycin-Resistant Enterococci and Carbapenem-Resistant Gram-Negative Bacteria in an Endemic Setting: Prevalence, Risk Factors, and Outcomes

Vancomycin Resistant Enterococci outbreak in neonatal unit and management of cases after discharge

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