Stool Colonization With Vancomycin-Resistant Enterococci in Healthcare Workers and Their Households

2002 ◽  
Vol 23 (1) ◽  
pp. 23-26 ◽  
Author(s):  
Joseph Baran ◽  
Jambunathan Ramanathan ◽  
Kathleen M. Riederer ◽  
Riad Khatib
Keyword(s):  
Healthcare Workers ◽  
Tertiary Care ◽  
Pfge Analysis ◽  
Hospital Employees ◽  
Vancomycin Resistant Enterococci ◽  
Prospective Assessment ◽  
Stool Specimens ◽  
Household Members ◽  
Vancomycin Resistant ◽  
Age Range

AbstractObjective:To determine the prevalence of stool colonization with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) and their families.Design:Prospective assessment of fecal colonization with VRE.Setting:A 603-bed, tertiary-care teaching hospital.Participants:Healthy volunteers recruited from hospital employees and their households were screened to exclude pregnancy, diabetes mellitus, immunosuppressive disorders, and recent use of antimicrobials.Intervention:Self-obtained stool swabs were used to obtain cultures. Isolated enterococci were screened for vancomycin resistance and species were identified. Intra-household isolates were genotyped using pulsed-field gel electrophoresis (PFGE).Results:The participants (n = 228; age range, 28 days to 80 years) were from 137 households with and 91 without employees who had contact with patients.Enterococcusspecies were isolated from 127 stool specimens (55.7%). VRE were detected in 12 individuals, representing 6E. casseliflavus, 5E. faecium, and 1E. gallinarum. VRE were more commonly isolated in employees who had contact with patients (5 of 52 vs 0 of 40; relative risk [RR], 1.9; 95% confidence interval [CI95], 1.5 to 2.2;P= .07) and their household members (10 of 137 vs 2 of 91; RR, 3.3; CI95, 0.7 to 14.8;P= .13). In 2 households (2 adults in a physician's household and an adult plus a child in a nurse's household) PFGE analysis demonstrated identical intra-household strains of vancomycin-resistantE. faecium.Conclusions:VRE colonization was found in 5.3% of screened stools and was more prevalent in HCWs who had contact with patients and their households. Identical PFGE patterns between 2 employees who had contact with patients and their household members demonstrated probable intra-household spread. Although the mode of acquisition was uncertain, the association with employees who had contact with patients suggests possible occupational sources. These findings demonstrate the spread of VRE within the household and implicate occupational risk for its acquisition.

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.

Risk of Hand or Glove Contamination After Contact With Patients Colonized With Vancomycin-ResistantEnterococcusor the Colonized Patients' Environment

2008 ◽  
Vol 29 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Mary K. Hayden ◽  
Donald W. Blom ◽  
Elizabeth A. Lyle ◽  
Charity G. Moore ◽  
Robert A. Weinstein
Keyword(s):  
Healthcare Workers ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Routine Care ◽  
Intact Skin ◽  
Vancomycin Resistant Enterococci ◽  
After Care ◽  
Before And After ◽  
Medical Intensive Care ◽  
Vancomycin Resistant

Objective.To estimate the level of hand or glove contamination with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) who touch a patient colonized with VRE and/or the colonized patient's environment during routine care.Design.Structured observational study.Setting.Medical intensive care unit of a 700-bed, tertiary-care teaching hospital.Participants.VRE-colonized patients and their caregivers.Methods.We obtained samples from sites on the intact skin of 22 patients colonized with VRE and samples from sites in the patients' rooms, before and after routine care, during 27 monitoring episodes. A total of 98 unique HCWs were observed during 131 HCW observations. Observers recorded the sites touched by HCWs. Culture samples were obtained from HCWs' hands and gloves before and after care.Results.VRE were isolated from a mean (±SD) of 55% ± 24% of patient sites (n= 256) and 17% ± 12% of environmental sites (n= 1,572). Most HCWs (131 [56%]) touched both the patient and the patient's environment; no HCW touched only the patient. Of 103 HCWs whose hand samples were negative for VRE when they entered the room, 52% contaminated their hands or gloves after touching the environment, and 70% contaminated their hands or gloves after touching the patient and the environment (P= .101). In a univariate logistic regression model, the risk of hand or glove contamination was associated with the number of contacts made (odds ratio, 1.1 [95% confidence interval, 1.01-1.19). In a multivariate model, the effect of the number of contacts could not be distinguished from the effect of type of contact (ie, touching the environment alone or touching both the patient and the environment). Overall, 37% of HCWs who did not wear gloves contaminated their hands, and 5% of HCWs who wore gloves did so (an 86% difference).Conclusion.HCWs were nearly as likely to have contaminated their hands or gloves after touching the environment in a room occupied by a patient colonized by VRE as after touching the colonized patient and the patient's environment. Gloves were highly protective with respect to hand contamination.

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.

Recovery of Both Vancomycin-Resistant Enterococci and Methicillin-ResistantStaphylococcus aureusFrom Culture of a Single Clinical Specimen From Colonized or Infected Patients

2009 ◽  
Vol 30 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Sang Hoon Han ◽  
Bum Sik Chin ◽  
Han Sung Lee ◽  
Su Jin Jeong ◽  
Hee Kyung Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Multivariate Logistic Regression Analysis ◽  
University Hospital ◽  
Cell Contact ◽  
Patient Risk ◽  
Clinical Specimens ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Objective.To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistantStaphylococcus aureus(MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.Design.A retrospective cohort and case-control study.Setting.A tertiary care university hospital and referral center in Seoul, Korea.Methods.We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.Results.The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00;P= .012), urinary catheterization (OR, 3.36;P= .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03;P< .001).Conclusion.We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer ofvanA,close observation and surveillance for vancomycin-resistantS. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.

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

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.

P210 Active screening of vancomycin-resistant enterococci colonization and the patient outcome in a tertiary care university hospital in Japan

2013 ◽  
Vol 42 ◽  
pp. S108
Author(s):  
T. Takata ◽  
T. Ohshiro ◽  
T. Hashimoto ◽  
H. Yoshimura ◽  
A. Togawa ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Tertiary Care ◽  
University Hospital ◽  
Active Screening ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

scholarly journals Decontamination of Targeted Pathogens from Patient Rooms Using an Automated Ultraviolet-C-Emitting Device

2013 ◽  
Vol 34 (5) ◽  
pp. 466-471 ◽  
Author(s):  
Deverick J. Anderson ◽  
Maria F. Gergen ◽  
Emily Smathers ◽  
Daniel J. Sexton ◽  
Luke F. Chen ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Environmental Services ◽  
Convenience Sample ◽  
Vancomycin Resistant Enterococci ◽  
Colony Forming Units ◽  
Before And After ◽  
Ultraviolet C ◽  
Vancomycin Resistant ◽  
Tertiary Care Hospitals ◽  
Uv C

Objective.To determine the effectiveness of an automated ultraviolet-C (UV-C) emitter against vancomycin-resistant enterococci (VRE),Clostridium difficile, andAcinetobacterspp. in patient rooms.Design.Prospective cohort study.Setting.Two tertiary care hospitals.Participants.Convenience sample of 39 patient rooms from which a patient infected or colonized with 1 of the 3 targeted pathogens had been discharged.Intervention.Environmental sites were cultured before and after use of an automated UV-C-emitting device in targeted rooms but before standard terminal room disinfection by environmental services.Results.In total, 142 samples were obtained from 27 rooms of patients who were colonized or infected with VRE, 77 samples were obtained from 10 rooms of patients withC. difficileinfection, and 10 samples were obtained from 2 rooms of patients with infections due toAcinetobacter. Use of an automated UV-C-emitting device led to a significant decrease in the total number of colony-forming units (CFUs) of any type of organism (1.07 log10reduction;P< .0001), CFUs of target pathogens (1.35 log10reduction;P< .0001), VRE CFUs (1.68 log10reduction;P< .0001), and C.difficileCFUs (1.16 log10reduction;P< .0001). CFUs ofAcinetobacteralso decreased (1.71 log10reduction), but the trend was not statistically significantP= .25). CFUs were reduced at all 9 of the environmental sites tested. Reductions similarly occurred in direct and indirect line of sight.Conclusions.Our data confirm that automated UV-C-emitting devices can decrease the bioburden of important pathogens in real-world settings such as hospital rooms.

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