Molecular Epidemiology of Vancomycin-Resistant Enterococci: A 2-Year Perspective

1999 ◽  
Vol 20 (10) ◽  
pp. 653-659 ◽  
Author(s):  
Valentina Stosor ◽  
Julie Kruszynski ◽  
Terra Suriano ◽  
Gary A. Noskin ◽  
Lance R. Peterson
Keyword(s):  
Molecular Epidemiology ◽  
Medical Center ◽  
Tertiary Care ◽  
Control Program ◽  
Restriction Endonuclease Analysis ◽  
Nosocomial Transmission ◽  
Care Hospital ◽  
Infection Control Program ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

AbstractObjective:To determine the molecular epidemiology of vancomycin-resistant enterococci (VRE) at our medical center in order to identify the extent of strain clonality and possible transmission patterns of this pathogen.Design:An important facet of our infection control program includes molecular typing of all clinical and surveillance isolates of VRE to determine transmission patterns in the hospital. Molecular strain typing is performed by restriction endonuclease analysis (REA) of genomic DNA. REA patterns are visually compared to categorize VRE strains into type and subtype designations.Setting:A 588-bed, university-affiliated, tertiary-care hospital and a neighboring 155-bed rehabilitation facility.Results:From January 1995 through December 1996, 379 VRE isolates were collected from 197 patients. Thirty-three genotypes were determined by REA typing; 15 genotypes were implicated in 29 instances of potential nosocomial transmission. Three major clusters of VRE involving patients on multiple nursing units and two adjacent hospitals were identified. The remaining instances of nosocomial transmission occurred in small patient clusters.Conclusions:In conclusion, the VRE epidemic at this medical center is polyclonal. VRE transmission patterns are complex, and, while large clusters do occur, the usual pattern of nosocomial acquisition of this pathogen occurs in the setting of “mini-clusters”.

scholarly journals Association between Vancomycin-Resistant Enterococci Bacteremia and Ceftriaxone Usage

2012 ◽  
Vol 33 (7) ◽  
pp. 718-724 ◽  
Author(s):  
James A. McKinnell ◽  
Danielle F. Kunz ◽  
Eric Chamot ◽  
Mukesh Patel ◽  
Rhett M. Shirley ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Medical Center ◽  
Tertiary Care ◽  
Health Concern ◽  
Care Hospital ◽  
Antimicrobial Usage ◽  
Vancomycin Resistant Enterococci ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Vancomycin Resistant

Objective.Vancomycin-resistant enterococci (VRE) have become a public health concern with implications for patient mortality and costs. Hospital antibiotic usage may impact VRE incidence, but the relationship is poorly understood. Animal investigations suggest that ceftriaxone may be associated with VRE proliferation. We measured antimicrobial usage and VRE bloodstream infection (VRE-BSI) incidence to test our hypothesis that increased ceftriaxone usage would be associated with a higher incidence of VRE-BSI.Design.Retrospective cohort study.Setting.University of Alabama at Birmingham Medical Center, a 900-bed urban tertiary care hospital.Participants.All patients admitted during the study period contributed data.Methods.We conducted a retrospective analysis of antimicrobial usage and VRE-BSI from 2005 to 2008 (43 months). Antimicrobial usage was quantified as days of therapy (DOTs) per 1,000 patient-days. VRE-BSI incidence was calculated as cases per 1,000 patient-days. Negative binomial regression with adjustment for correlation between consecutive observations was used to measure the association between antimicrobial usage and VRE-BSI incidence at the hospital- and care-unit levels.Results.VRE-BSI incidence increased from 0.06 to 0.17 infections per 1,000 patient-days. Hospital VRE-BSI incidence was associated with prior-month ceftriaxone DOTs (incidence rate ratio, 1.38 per 10 DOTs; P = .005). After controlling for ceftriaxone, prior-month cephalosporin usage (class) was not predictive of VRE-BSI (P = .70). Similarly, prior-month usage of piperacillin-tazobactam, ceftazidime, cefepime, cefazolin, or vancomycin was not predictive of VRE-BSI when considered individually (P ≥ .4 for all comparisons). The final model suggests that type of intensive care unit was related to VRE-BSI incidence.Conclusions.Ceftriaxone usage in the prior month, but not cephalosporin (class) or vancomycin usage, was related to VRE-BSI incidence. These findings suggest that an antimicrobial stewardship program that limits ceftriaxone may reduce nosocomial VRE-BSI incidence.

Molecular epidemiology of vancomycin resistant enterococci in a tertiary care hospital in Saudi Arabia

2016 ◽  
Vol 97 ◽  
pp. 79-83 ◽  
Author(s):  
Ali M. Somily ◽  
Maha M. Al-Mohizea ◽  
Muhammed M. Absar ◽  
Amal J. Fatani ◽  
Afaaf M. Ridha ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Molecular Epidemiology ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Prevalence of Vancomycin Resistant Enterococci in Various Clinical Specimens in Tertiary Care Hospital in North Delhi

2012 ◽  
Vol 3 (3) ◽  
pp. 141-144
Author(s):  
Swati Chaudhary ◽  
◽  
Swastika Aggarwal ◽  
Pawan Kumar ◽  
SK Aggarwal SK Aggarwal ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Clinical Specimens ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

scholarly journals A Japanese traditional medicine Hochuekkito promotes negative conversion of vancomycin-resistant Enterococci

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Junko Kohno ◽  
Tsuyoshi Kawamura ◽  
Akiko Kikuchi ◽  
Tetsuya Akaishi ◽  
Shin Takayama ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Tertiary Care ◽  
Albumin Level ◽  
Kampo Medicine ◽  
Care Hospital ◽  
Intestinal Immunity ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Japanese Traditional Medicine ◽  
Negative Conversion

AbstractVancomycin-resistant enterococci (VRE) are prominent causes of nosocomial infections. Japanese traditional (Kampo) medicine promotes intestinal immunity and protects against bacterial infections. We assessed potential differences in the clinical course of VRE-positive patients, based on their characteristics and treatment with Kampo medicines. This retrospective observational study collected data from VRE-positive patients from August 2018 to July 2019 at a tertiary-care hospital in Japan. The data of 122 consecutive VRE-positive inpatients were analyzed. Sixty-nine patients were treated with probiotics, among whom, 18 were further treated with Kampo medicines. Twenty-six of the 122 patients subsequently died. In univariate analyses, subsequent VRE negative conversion significantly reduced the mortality of VRE-detected patients (p = .0003). Administration of probiotics (p = .0065) and Kampo medicines with probiotics (p = .0002), especially of the Kampo medicine hochuekkito (p = .0014), and a higher serum albumin level positively contributed to the subsequent VRE negative conversion. Multivariate analyses demonstrated that Kampo medicines and body mass index contributed to VRE negative conversion. Hochuekkito shortened the time needed for VRE negative conversion (p = 0.0485). Administration of Kampo medicines, especially of hochuekkito, in addition to probiotics in VRE patients may promote VRE negative conversion.

scholarly journals A descriptive study of vancomycin resistant enterococci in Tertiary Care Hospital of Western India

2020 ◽  
Vol 7 (3) ◽  
pp. 230-236
Author(s):  
Ridhdhi B Patel ◽  
◽  
Geeta M Vaghela ◽  
Manali Shah ◽  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Descriptive Study ◽  
Western India ◽  
Care Hospital ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Prevention of Infections Associated With Permanent Cardiac Antiarrhythmic Devices by Implementation of a Comprehensive Infection Control Program

2004 ◽  
Vol 25 (6) ◽  
pp. 492-497 ◽  
Author(s):  
Abraham Borer ◽  
Jacob Gilad ◽  
Eytan Hyam ◽  
Francisc Schlaeffer ◽  
Pnina Schlaeffer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infection Control ◽  
Medical Center ◽  
Tertiary Care ◽  
Pacemaker Implantation ◽  
Relative Weight ◽  
Control Program ◽  
Cardiac Device ◽  
Infection Control Program

AbstractObjective:To implement a comprehensive infection control (IC) program for prevention of cardiac device-associated infections (CDIs).Design:Prospective before-after trial with 2 years of follow-up.Setting:A tertiary-care, university-affiliated medical center.Patients:A consecutive sample of all adults undergoing cardiac device implantation between 1997 and 2002.Intervention:An IC program was implemented during late 2001 and included staff education, preoperative modification of patient risk factors, intraoperative control of strict aseptic technique, surgical scrubbing and attire, control of environmental risk factors, optimization of antibiotic prophylaxis, postoperative wound care, and active surveillance. The clinical endpoint was CDI rates.Results:Between 1997 and 2000, there were 7 CDIs among 725 procedures (mean annual CDI incidence, 1%). During the first 9 months of 2001, there were 7 CDIs among 167 procedures (4.2%; P = .007): CDIs increased from 7 among 576 to 3 among 124 following pacemaker implantation (P = .39) and from 0 among 149 to 4 among 43 following cardioverter-defibrillator implantation (P = .002). Of the 14 CDIs, 5 involved superficial wounds, 7 involved deep wounds, and 2 involved endocarditis. Following intervention, there were no cases of CDI among 316 procedures during 24 months of follow-up (4.2% reduction; P = .0005).Conclusions:We observed a high CDI rate associated with substantial morbidity. IC measures had an impact on CDI. Although the relative weight of each measure in the prevention of CDI remains unknown, our results suggest that implementation of a comprehensive IC program is feasible and efficacious in this setting.

PREVALENCE OF HIGH LEVEL AMINOGLYCOSIDE RESISTANCE AND VANCOMYCIN RESISTANT ENTEROCOCCI IN ENTEROCOCCAL ISOLATES IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 3-5
Author(s):  
Sunita Agarwal ◽  
Nazneen Pathan ◽  
Shivra Batra ◽  
Rajni Sharma
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Automated System ◽  
Care Hospital ◽  
Enterococcus Species ◽  
Aminoglycoside Resistance ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
High Level

Introduction: The emergence of High Level Aminoglycoside Resistance (Resistant to Gentamycin and Streptomycin) and Vancomycin Resistant Enterococci among Indoor and Intensive Care Unit admitted patient presents a serious challenge for clinicians. Objective: To determine Enterococcal burden in blood and urine specimens and to detect the prevalence of High Level Aminoglycoside Resistance and Vancomycin Resistant Enterococci. Material & Methods: One hundred ten Enterococci were isolated from blood and urine samples and processed according to standard laboratory protocol. Species identication and sensitivity was done using the VITEK 2 automated system (Biomerieux France) with the cards GPID and AST 67 respectively. Results: Out of 110 Enterococci isolates, 36 were from blood and 74 from urine were detected. Different Species isolated were Enterococcal faecium (59%), Enterococcal faecalis (34%), Enterococcal rafnosus (2.7%), Enterococcal gallinarum (1.8%), Enterococcal casseliavus (0.9%) and Enterococcal duran (0.9%).Out of 36 blood isolates, 14 (38%) were found to be both High Level Gentamycin Resistant (HLGR) & High Level Streptomycin Resistant (HLSR), 10 (27%) were only HLGR and 8 (22%) were only HLSR. 20 strain (55%) of Enterococcus species isolated in blood were VRE. All VRE strains were found to be resistant to both aminoglycosides ( HLAR).Among the 74 urinary isolates, 24 (34%) were found to be both HLGR & HLSR, only HLGR was observed in 20 (27%) and HLSR was observed in 11 (14%) isolates. 24 strains (34%) of Enterococcus species were found to be vancomycin resistant in urine. 23 strains out of 24 were resistant to high level of aminoglycosides. Conclusion: The prevalence of HLAR and VRE is very high among Enterococcus specimens from indoor/ intensive care unit patients. Early species identication and antibiotic sensitivity result can help in better clinical outcome.

scholarly journals Detection of Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci on the Gowns and Gloves of Healthcare Workers

2008 ◽  
Vol 29 (7) ◽  
pp. 583-589 ◽  
Author(s):  
Graham M. Snyder ◽  
Kerri A. Thorn ◽  
Jon P. Furuno ◽  
Eli N. Perencevich ◽  
Mary-Claire Roghmann ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Medical Center ◽  
Tertiary Care ◽  
Routine Care ◽  
Inpatient Setting ◽  
Jejunostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Vancomycin Resistant Enterococci ◽  
Increased Risk ◽  
Vancomycin Resistant

Objective.To assess the rate of and the risk factors for the detection of methicillin-resistantS. aureus(MRSA) and vancomycin-resistant enterococci (VRE) on the protective gowns and gloves of healthcare workers (HCWs).Methods.We observed the interactions between HCWs and patients during routine clinical activities in a 29-bed medical intensive care unit at the University of Maryland Medical Center, an urban tertiary care academic hospital. Samples for culture were obtained from HCWs' hands prior to their entering a patient's room, from HCWs' disposable gowns and gloves after they completed patient care activities, and from HCWs' hands immediately after they removed their protective gowns and gloves.Results.Of 137 HCWs caring for patients colonized or infected with MRSA and/or VRE, 24 (17.5%; 95% confidence interval, 11.6%–24.4%) acquired the organism on their gloves, gown, or both. HCW contact with the endotracheal tube or tracheostomy site of a patient (P< .05), HCW contact with the head and/or neck of a patient (P< .05), and HCW presence in the room of a patient with a percutaneous endoscopic gastrostomy and/or jejunostomy tube (P< .05) were associated with an increased risk of acquiring these organisms.Conclusions.The gloves and gowns of HCWs frequently become contaminated with MRSA and VRE during the routine care of patients, and particularly during care of the patient's respiratory tract and any associated indwelling devices. As part of a larger infection control strategy, including high-compliance hand disinfection, they likely provide a useful barrier to transmitting antibiotic-resistant organisms among patients in an inpatient setting.

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