Vancomycin-Resistant Enterococcus faecium in Hospitalized Children

Abstract

Vancomycin use may predispose to colonization with vancomycin-resistant E faecium. Vancomycin-resistant E faecium may be nosocomially spread. Contact isolation and restriction of vancomycin use may prevent spread of vancomycin-resistant E faecium.

Does vancomycin prescribing intervention affect vancomycin-resistant enterococcus infection and colonization in hospitals? A systematic review

“…Of the 2027 citations identified after literature searches, 12 were judged to meet our inclusion criteria and were included in this review [20,26-36]. All included studies presented pre- and post-intervention data, with the prevalence or incidence of VRE colonization and/or infection compared before and after implementation of a vancomycin use reduction intervention at the institution or ward under investigation.…”

“…All studies lacked a control group and none removed and reintroduced interventions. Eleven of 13 took place at a single teaching hospital [20,26-29,31-33,35,36], one was at a non-teaching community hospital [30] and one was a multi-center trial of both academic and community hospitals [34]. One study reported initial cases of VRE colonization [26], two reported current outbreaks without an endemic problem [27,28], and one reported a superimposed outbreak on an endemic problem with VRE infections [31].…”

“…Eleven of 13 took place at a single teaching hospital [20,26-29,31-33,35,36], one was at a non-teaching community hospital [30] and one was a multi-center trial of both academic and community hospitals [34]. One study reported initial cases of VRE colonization [26], two reported current outbreaks without an endemic problem [27,28], and one reported a superimposed outbreak on an endemic problem with VRE infections [31]. Aside from the multi-site study that did not specify outbreak status [34], the remaining studies described a VRE problem of several years duration [20,26,29,30,32,33,35,36].…”

“…One study reported initial cases of VRE colonization [26], two reported current outbreaks without an endemic problem [27,28], and one reported a superimposed outbreak on an endemic problem with VRE infections [31]. Aside from the multi-site study that did not specify outbreak status [34], the remaining studies described a VRE problem of several years duration [20,26,29,30,32,33,35,36]. No article provided explicit definitions for outbreak vs. endemicity, and classifications may have varied.…”

“…Data from the largest ecologic study to date showed that vancomycin was the most significant 'modifiable' risk factor leading to VRE colonization [25]. Yet results from studies investigating the impact of reductions in vancomycin use on VRE colonization and infection have been heterogeneous [20,26-36]. We conducted a systematic review of the available literature to evaluate the impact of reducing vancomycin use through vancomycin prescribing interventions on the prevalence and incidence of VRE colonization and infection in US hospitals.…”