Factors Associated with Vancomycin-Resistant Enterococcus Colonization in Patients Transferred to Emergency Departments in Korea

BACKGROUND: Vancomycin-resistant enterococci (VRE) infections have become a major healthcare-associated pathogen problem worldwide. Nosocomial VRE infections could be effectively controlled by screening patients at high risk of harboring VRE and thereby lowering the influx of VRE into healthcare centers. In this study, we evaluated factors associated with VRE colonization in patients transferred to emergency departments, to detect patients at risk for VRE carriage. METHODS: This study was conducted in the emergency department of a medical college-affiliated hospital in Korea. Every patient transferred to the emergency department and admitted to the hospital from January to December 2016 was screened for VRE using rectal cultures. In this cross-sectional study, the dependent variable was VRE colonization and the independent variables were demographic and clinical factors of the patients and factors related to the transferring hospital. Patients were divided into two groups, VRE and non-VRE, and previously collected patient data were analyzed. Then we performed logistic regression analyses of characteristics that differed significantly between groups. RESULTS: Out of 650 patients, 106 (16.3%) had positive VRE culture results. Significant variables in the logistic analysis were transfer from geriatric long-term care hospital (adjusted odds ration [aOR]: 8.017; 95% confidence interval [CI]: 1.378–46.651), hospital days (4–7 days; aOR: 7.246; 95% CI: 3.229–16.261), duration of antimicrobial exposure (1–3 days; aOR: 1.976; 95% CI: 1.137–3.436), and age (aOR: 1.025; 95% CI: 1.007–1.043). CONCLUSION: VRE colonization in patients transferred to the emergency department is associated primarily with factors related to the transferred hospitals rather than demographic and clinical characteristics.

Progress on the resistance mechanism of Enterococcus to linezolid / 中华临床感染病杂志

Enterococcus is an opportunistic pathogen of nosocomial infection.In recent years, the resistance rate of Enterococcus to antimicrobial agents is increasing with the widespread use of antibiotics, even leading to the development of vancomycin-resistant Enterococcus(VRE).Linezolid is a synthetic oxazolidinone antibiotic, which less likely to generates the cross-resistance with other antimicrobial agents that inhibit bacterial protein synthesis,so it has been regarded as the last line of defense for VRE.However, since the linezolid has appeared on the market, the reports of linezolid-resistant Enterococcus have also emerged.This article reviews the resistance mechanisms of Enterococcus to linezolid in order to provide reference for resistance surveillance as well as the research and development of new antimicrobial agents.

Bacteremia caused by Leuconostoc species : 6-case series / 고신대학교의과대학학술지

Leuconostoc species are Gram-positive coccobacilli and are used in dairy products and are intrinsically resistant to vancomycin. Leuconostoc infections are rare in humans, usually occurring in immune-compromised patients. We describe 6 patients with Leuconostoc bacteremia at Dong-A university hospital between 1990 and 2015. One isolate (L. lactis) was identified to species level using 16S rRNA gene sequencing analysis. All patients had underlying diseases and 5 patients underwent procedures that interrupted the normal integumentary defense. Four patients died within 30 days after being identified as carrying Leuconostoc species.

Colonización por enterococo resistente a vancomicina en pacientes internados en un hospital de Lima, Perú / Colonization by Enterococcal Strains Resistant to Vancomycin in Patients from a Hospital in Lima, Peru

RESUMEN Con el objetivo de determinar la frecuencia de colonización por el enterococo resistente a vancomicina (ERV), el genotipo de resistencia y los factores asociados, se realizó un estudio de tipo transversal durante noviembre y diciembre del 2013 en el Hospital Nacional Cayetano Heredia en Lima, Perú. Se encontró una frecuencia de colonización por ERV de 6,2% (IC 95%: 1,67-10,73), todas las cepas aisladas tenían el genotipo de resistencia vanA, y se halló que las variables hospitalización previa (p=0,001) y el uso de cefalosporinas de tercera generación (p=0,016) estaban asociadas a la colonización por ERV. En conclusión, existe colonización perianal por ERV en los diversos servicios de hospitalización, el gen vanA podría ser transmitido a gérmenes más virulentos y ocasionar la aparición de la bacteria Staphylococcus aureus resistente a vancomicina (VRSA). Es necesario adoptar medidas de control de infecciones para evitar la transmisión de esta bacteria en el ambiente hospitalario.

ABSTRACT This cross-sectional study was conducted from November to December of 2013 at the Cayetano Heredia National Hospital in Lima, Peru, to determine the rate of infection with vancomycin-resistant enterococcus (VRE), the resistance genotype, and associated factors. The rate of infection with VRE was 6.2% (95% confidence interval [CI]: 1.67-10.73) and the resistance genotype isolated from all strains was the vanA gene. The factors associated with colonization with VRE were previous hospitalizations (p = 0.001) and the use of third-generation cephalosporins (p = 0.016). In conclusion, perianal colonization with VRE is present in many hospital services. Moreover, the vanA gene may cause resistance to vancomycin and promote the development of vancomycin-resistant Staphylococcus aureus. Therefore, infection control measures should be adopted to prevent the dissemination of this bacterial strain in hospital settings.

Detection of vancomycin-resistant enterococci (VRE) in stool specimens submitted for Clostridium difficile toxin testing

Abstract The aim of this study was to determine the association between Clostridium difficile (C. difficile) and vancomycin-resistant Enterococcus (VRE) and efficacy of screening stools submitted for C. difficile toxin assay for prevalence of VRE. Between April 2012 and February 2014, 158 stool samples submitted for C. difficile toxin to the Marmara University Microbiology Laboratory, were included in the study. Stool samples were analyzed by enzyme immuno assay test; VIDAS (bioMerieux, France) for Toxin A&B. Samples were inoculated on chromID VRE (bioMerieux, France) and incubated 24 h at 37 °C. Manuel tests and API20 STREP (bioMerieux, France) test were used to identify the Enterococci species. After the species identification, vancomycin and teicoplanin MIC's were performed by E test and molecular resistance genes for vanA vs vanB were detected by polymerase chain reaction (PCR). Of the 158 stool samples, 88 were toxin positive. The prevalence of VRE was 17%(n:19) in toxin positives however, 11.4% in toxin negatives(n:70). All VRE isolates were identified as Enterococcus faecium. These results were evaluated according to Fischer's exact chi-square test and p value between VRE colonization and C. difficile toxin positivity was detected 0.047 (p < 0.05). PPV and NPV were 79% and 47% respectively. In our study, the presence of VRE in C. difficile toxin positives is statistically significant compared with toxin negatives (p < 0.05). Screening for VRE is both additional cost and work load for the laboratories. Therefore VRE screening among C. difficile toxin positive samples, will be cost effective for determination of high risk patients in the hospitals especially for developing countries.

Rapid detection of high-level vancomycin-resistant genes, vanA, vanB, vanD and vanM, in enterococci / 中华传染病杂志

Objective To develop a multiple polymerase chain reaction (PCR) technique based assay for rapid detection of vanA, vanB, vanD and vanM in high-level vancomycin-resistant enterococci.Methods After analyzing the uncleotide sequence divergence among D-Ala∶D-Lac ligase genes, an multiplex PCR assay for vanA, vanB, vanD and vanM genes in high-level vancomycin-resistant enterococci were designed.By using recombination plasmids containing vanA, vanB, vanD and vanM genes as positive control, and non-vancomycin resistant enterococci (non-VRE) common pathogenic bacterial DNA as negative control, the sensitivity and specificity of the assay were evaluated.Fifty vancomycin-resistant enterococci (VRE) isolates were detected by the assay.Fifty clinical strains of VRE were isolated from 9 hospitals in Shanghai from January 2006 to December 2014.The results were compared with the conventional PCR and sequencing methods.Results The identity of the D-Ala∶D-Lac ligase genes were 60.8%-71.3% of vanA, vanB, vanD and vanM genes.The multiplex PCR assay could identify the genotypes of the positive control samples accurately.No false positive results were found in negative control samples.Among fifty VRE strains detected by the assay, 18 were vanA genotype and 32 were vanM genotype.Comparison of the multiplex PCR assay and sequencing methods revealed sensitivity and specificity of 100%.The detection limit of the assay was 2×10 copies/PCR reaction.The experiment could be done within 3.5 h.Conclusions A multiplex PCR assay is developed to rapid identify the genotype of the high-level vancomycin-resistant enterococci, which can be used for the molecular epidemiology research and detection of VRE.

Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a Tertiary Care Hospital in Northern India.

Purpose: To determine the prevalence, genotype, risk factors and mortality in patients having vancomycin-resistant Enterococcus faecalis (VR E. faecalis) and Enterococcus faecium (VR E. faecium) infection or colonisation. Materials and Methods: A total of 1488 clinical isolates of E. faecalis and E. faecium were tested for vancomycin resistance by phenotypic (disk diffusion, E-test and broth micro-dilution test) and genotypic polymerase chain reaction methods. Records of all 1488 patients who had E. faecalis or E. faecium infection or colonisation were reviewed for the identification of host, hospital and medication related risk factors associated with VR E. faecalis and VR E. faecium. Results: Of 1488 isolates, 118 (7.9%) were vancomycin-resistant and their distributions were as follows: E. faecalis =72 (61%) and E. faecium =46 (39%). All 118 vancomycin-resistant isolates were vanA genotype (minimum inhibitory concentration [MIC] to vancomycin ≥64 μg/ml and MIC to teicoplanin ≥32 μg/ml) and none of the isolates was vanB genotype. Multivariate logistic regression analysis identified ventilator support and hospital stay for ≥48 h as independent risk factors associated with VR E. faecalis and VR E. faecium infection or colonisation. Hospital stay ≥48 h was the only independent risk factor for mortality in patients infected with vancomycin-resistant enterococci. Conclusions: Strategies to limit the nosocomial infection especially in patients on ventilator support can reduce VRE incidence and related mortality.

Phenotypic speciation of enterococci with special reference to prevalence, virulence and antimicrobial resistance.

Background: Now considered as one of the most important Nosocomial pathogen, enterococci have been found to possess virulence factors like biofilm formation and are increasingly exhibiting antimicrobial resistance in India. This study was undertaken to estimate the prevalence of enterococci from various clinical samples simultaneously correlating their virulence property and antimicrobial resistance, in addition to speciation. Methods: A total of 126 enterococcal isolates from various clinical samples were included and processed according to standard protocols and speciation was based on Facklam and Collins conventional method. Virulence determinants like hemolysin, gelatinase and biofilm formation were assessed by phenotypic tests. Antibacterial susceptibility pattern was determined by Kirby Bauer disc diffusion method with recommended drugs including high level aminoglycoside resistance. Minimum inhibitory concentration (MIC) for vancomycin was done by E-test. Results: Out of 1746 clinical samples, enterococci accounted for 7.22%. They consisted of E. faecium 52.38%, E. faecalis 32.54%, and E. avium 15.08% isolated from urine 8.26%, pus 8.44%, blood 0.56% and body fluids 1.28%. Study on virulence factors revealed that 19.84% strains produced gelatinase, 18.25% produced hemolysin and 73.81% produced biofilm. High level resistance to gentamycin and streptomycin were 4.76% and 5.56% respectively. Vancomycin resistance was 3.17%. Conclusions: This study indicates the change in epidemiology of enterococcal infections from E. faecalis to E. faecium and low prevalence of vancomycin resistant enterococcus (VRE) in our region. To maintain the low level of resistance, improvement of antibiotic policies and hospital infection control is essential.

Gene chip technique in detection of vancomycin-resistant Enterococcus gene / 军事医学

Objective To develop a detection method based on the technology of gene chips which can quickly distinguish genes of Enterococcus faecalis, E.faecium and vancomycin resistance.Methods Based on the specific gene ( ddl) sequences of two types of Enterococcus from GenBank, oligonucleotide probes which could detect and distinguish special genes and drug resistance genes ( vanA,vanB) of Enterococcus were designed and compounded.Then,the probes were dotted to modified slide.The target DNA fragments of vancomycin-resistant Enterococcus ( VRE) were labeled with biotin by multiple PCR amplification, and then hybridized with oligonucleotide probes on slide.The results were analyzed by portable imager.The multiple PCR system, hybridization reaction and condition of the chemiluminescence method were optimized before the specificity, sensitivity and reproducibility of the chip were evaluated.Results One universal primer, four specific primers, one universal probe and four specific probes were selected.This gene chip was demonstrated of high specificity and repeatability.The detection sensitivity was 103 CFU/ml.The gene chip detection results of 10 clinical samples were basically consistent with the drug sensitivity test ( 8/10 ) .Conclusion A gene chip technique for the detection of VRE is established successfully.It is possible to distinguish the type of VRE and detect the genetic phenotypes of drug resistance by gene chip technique.

Distribution of vancomycin-resistant genes and virulence genes in vancomycin-resistant Enterococcus isolates from intensive care unit / 中华临床感染病杂志

Objective To investigate the distribution of vancomycin-resistant genes and virulence genes in vancomycin-resistant Enterococcus (VRE) isolates from intensive care unit (ICU).Methods A total of 180 anal swabs were collected from patients in ICU in Tianjin Medical University General Hospital during September 2012 and May 2013.VRE strains were screened by ChromID agar method.Vitek 2 Compact system was used in drug sensitivity test,and the sensitivities to vancomycin and teicoplanin were further determined using Kirby-Bauer disk diffusion method.Vancomycin resistant genes vanA,vanB,vanC1 and virulence genes esp,hyl were detected by polymerase chain reaction(PCR).Results Nineteen strains of vancomycin resistant Enterococcusfaecium were isolated from 180 anal swabs.All 19 VRE isolates were resistant to both vancomycin and teicoplanin,while they were susceptible to linezolid and tigecycline.All VRE isolates carried vanA and esp genes,and hyl gene was positive in 10 isolates.Conclusions VRE isolates from ICU are highly resistant to commonly used antibacterial agents,and most isolates carry vancomycin-resistant genes and virulence genes.Linezolid and tigecycline may be recommended for VRE infection in ICU.

Risk Factors for Prolonged Carriage and Reacquisition of Vancomycin-resistant Enterococci / 병원감염관리

BACKGROUND: Patients infected with vancomycin-resistant enterococci (VRE) are kept in isolation to prevent the spread of VRE in medical facilities. However, decision-making regarding isolation can be challenging at the time of re-admission of previously VRE-colonized or infected patients who have not been examined for VRE infections for a long time. This study focused on providing guidelines for isolating VRE patients based on the analysis of risk factors for prolonged carriage and reacquisition of VRE. METHODS: A retrospective review was performed on medical records of patients who were diagnosed with VRE infections at a university hospital in 2009. Durations of colonization and negative conversion of VRE were estimated by Kaplan-Meier methods. Prolonged duration of VRE infections and risk factors for reacquisition were analyzed using Cox's proportional hazard model. RESULTS: Among 220 VRE-colonized patients, 132 were cleared, and 30 reacquired after negative conversion of VRE. The median duration of colonization was 33.1 weeks, and the median clearance period was 19.4 weeks. Patients who were admitted via the emergency department and treated with glycopeptides tended to have prolonged duration of VRE colonization. Prolonged hospitalization and metronidazole therapy increased the risk of reacquisition more rapidly. CONCLUSION: Treatment with glycopeptides, metronidazole antibiotic therapy, history of admission via the emergency department, and prolonged hospitalization can affect to prolonged carriage and reacquisition of VRE. Consider carefully the release of isolation of VRE patients with these risk factors.

Tendencias de la resistencia a antibióticos en Medellín y en los municipios del área metropolitana entre 2007 y 2012: resultados de seis años de vigilancia / Trends in antibiotic resistance in Medellín and municipalities of the Metropolitan Area between 2007 and 2012: Results of six years of surveillance

Introducción. La resistencia bacteriana es un fenómeno mundial, pero su comportamiento varía en el tiempo y el espacio, confiriéndole importancia a los sistemas de vigilancia locales. Objetivo. Determinar las tendencias de la resistencia a antibióticos entre 2007 y 2012 en instituciones hospitalarias de Medellín y del Área Metropolitana del Valle de Aburrá. Materiales y métodos. Entre 2007 y 2012 se obtuvieron los porcentajes de resistencia a antibióticos marcadores en 22 instituciones, utilizando el programa Whonet 5.6. Se empleó la guía del Clinical and Laboratory Standards Institute (CLSI) de los años 2009 y 2012 para interpretar los resultados de las pruebas de sensibilidad. Con el programa Epi-Info 6.04 se analizaron tendencias por medio de la prueba de ji al cuadrado de tendencia lineal con un nivel de confianza de 95 %; se consideró significativo un valor de p=0,05. Resultados. Se observó una disminución de la resistencia a oxacilina en S taphylococcus aureus (p=0,0006) y un incremento de la resistencia a vancomicina en Enterococcus faecium (p=0,0000). En Escherichia coli y Serratia marcescens se observó un incremento de la resistencia a ceftazidima, en contraste con una disminución en Klebsiella pneumoniae (p=0,0000) y Enterobacter cloacae (p=0,058). Para K. pneumoniae, S. marcescens y E. cloacae se observó un incremento de la resistencia a carbapenémicos, en contraste con una disminución en Pseudomonas aeruginosa y Acinetobacter baumannii. Conclusiones. La vigilancia de la resistencia permitió obtener hallazgos importantes como la emergencia de E. faecium resistente a la vancomicina y enterobacterias resistentes a los carbapenémicos. Es indispensable conocer el uso de antibióticos en la región para establecer su influencia en los perfiles encontrados, además de garantizar la calidad de la información emanada de los laboratorios de microbiología.

Introduction: Bacterial resistance is a global phenomenon, but it presents geographic and temporal variations; this is the importance of local surveillance programs. Objective: To determine trends in antibiotic resistance in hospitals between 2007 and 2012 in Medellín and its Metropolitan Area. Materials and methods: Percentages of antibiotic resistance between 2007 and 2012 in 22 institutions were obtained using WHONET 5.6 program. For interpretation of susceptibility results, CLSI standards of 2009 and 2012 were used. Using the Epi-Info 6.04 program a trends analysis of antibiotic resistance was done using the chi-square for linear trend with a confidence level of 95%, a value of p=0.05 was considered significant. Results: In six years of surveillance of antibiotic resistance we found a decrease of oxacillin resistance in Staphylococcus aureus (p=0.0006) and an increase of vancomycin resistance in Enterococcus faecium (p=0.0000). In Escherichia coli and Serratia marcescens an increase of resistance to ceftazidime was found, in contrast to a decrease in Klebsiella pneumoniae (p=0.0000) and Enterobacter cloacae (p=0.058). K. pneumoniae , S. marcescens and E. cloacae showed an increase of carbapenem resistance in contrast to a reduction of carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii . Conclusions: The resistance surveillance identified important findings as the emergence of E. faecium resistant to vancomycin and carbapenem-resistant Enterobacteriaceae . It is essential to determine the antibiotic use in the region to establish their influence on the resistance profiles, as well as ensuring the quality of information and microbiological procedures in the microbiology laboratories.

Evaluation of PCR-Reverse Blot Hybridization Assay, REBA Sepsis-ID Test, for Simultaneous Identification of Bacterial Pathogens and mecA and van Genes from Blood Culture Bottles

BACKGROUND: The aim of this study was to evaluate a newly developed PCR-based reverse blot hybridization assay (PCR-REBA), REBA Sepsis-ID (M&D, Wonju, Korea), to rapidly detect the presence of bacteremia and antimicrobial resistance gene in blood culture samples. METHODS: One thousand four hundred consecutive blood culture samples from patients with a delta neutrophil index greater than 2.7% were selected from March to July in 2013. Three hundred positive and 1,100 negative for bacterial growth in blood culture bottles samples were tested by conventional and real-time PCR-REBA, respectively. RESULTS: The overall agreement between the conventional identification test and the REBA Sepsis-ID test was 95.3% (286/300). Agreement for gram-positive bacteria, gram-negative bacteria, fungi, and polymicrobials was 94.5% (190/201), 97.3% (71/73), 100% (14/14), and 91.7% (11/12), respectively. The detection rate of the mecA gene from methicillin-resistant Staphylococcus isolates was 97.8% (90/92). The vanA gene was detected in one blood culture sample from which vancomycin-resistant Enterococcus was isolated. When the cycle threshold for real-time PCR was defined as 30.0, 2.4% (26/1,100) of negative blood culture samples tested positive by real-time PCR. CONCLUSIONS: The REBA Sepsis-ID test is capable of simultaneously and quickly detecting both causative agents and antimicrobial resistance genes, such as mecA and van, in blood culture positive samples.

Presence of virulence factors in Enterococcus faecalis and Enterococcus faecium susceptible and resistant to vancomycin

Despite the increasing importance of Enterococcus as opportunistic pathogens, their virulence factors are still poorly understood. This study determines the frequency of virulence factors in clinical and commensal Enterococcus isolates from inpatients in Porto Alegre, Brazil. Fifty Enterococcus isolates were analysed and the presence of the gelE, asa1 and esp genes was determined. Gelatinase activity and biofilm formation were also tested. The clonal relationships among the isolates were evaluated using pulsed-field gel electrophoresis. The asa1, gelE and esp genes were identified in 38%, 60% and 76% of all isolates, respectively. The first two genes were more prevalent in Enterococcus faecalis than in Enterococcus faecium, as was biofilm formation, which was associated with gelE and asa1 genes, but not with the esp gene. The presence of gelE and the activity of gelatinase were not fully concordant. No relationship was observed among any virulence factors and specific subclones of E. faecalis or E. faecium resistant to vancomycin. In conclusion, E. faecalis and E. faecium isolates showed significantly different patterns of virulence determinants. Neither the source of isolation nor the clonal relationship or vancomycin resistance influenced their distribution.

Detection of vanC 1 gene transcription in vancomycin-susceptible Enterococcus faecalis

Here we report the presence and expression levels of the vanC 1 and vanC 2/3 genes in vancomycin-susceptible strains of Enterococcus faecalis. The vanC 1 and vanC 2/3 genes were located in the plasmid DNA and on the chromosome, respectively. Specific mRNA of the vanC 1 gene was detected in one of these strains. Additionally, analysis of the vanC gene sequences showed that these genes are related to the vanC genes of Enterococcus gallinarum and Enterococcus casseliflavus. The presence of vanC genes is useful for the identification of E. gallinarum and E. casseliflavus. Moreover, this is the first report of vanC mRNA in E. faecalis.

Evaluation of Vancomycin Resistance 3 Multiplexed PCR Assay for Detection of Vancomycin-Resistant Enterococci from Rectal Swabs

BACKGROUND: Active screening for vancomycin-resistant enterococci (VRE) using rectal specimens is recommended to limit the spread of antimicrobial resistance within certain high-risk populations. We evaluated the diagnostic performance of Vancomycin Resistance 3 Multiplexed Tandem PCR assay (AusDiagnostics, Australia), a rapid multiplex real-time PCR assay that detects vanA and/or vanB. METHODS: Two-hundred-and-eleven rectal swabs from Hematology and Oncology unit were submitted for VRE surveillance via direct detection of vanA and/or vanB by culture and by using Vancomycin Resistance 3 Multiplexed Tandem PCR assay. Enterococci were identified to the species level by using standard biochemical tests and BD Phoenix Automated Microbiology System (BD Diagnostic Systems, USA). Vancomycin susceptibility of enterococci was determined using Etest (BioMerieux, France). RESULTS: Compared to the culture method, Vancomycin Resistance 3 Multiplexed Tandem PCR assay had a sensitivity of 84.0%, specificity of 98.8%, positive predictive value (PPV) of 91.3%, and negative predictive value (NPV) of 97.6%. The assay failed to detect 18 (8.5%) specimens because of the presence of PCR inhibitors; of the remaining 193 specimens, 25 (12.9%) were positive, 23 for vanA, and 2 for vanB. Although both sensitivity and specificity for vanA VRE was 100% compared to the culture method, all vanB-positive specimens tested negative by VRE culture. CONCLUSIONS: Vancomycin Resistance 3 Multiplexed Tandem PCR assay is a rapid and laborsaving option for VRE surveillance for direct use on rectal swabs. However, the high rate of PCR failure owing to the inhibitors in the specimens and the low specificity for vanB should be considered when interpreting the results.

Risk Factors and Clinical Outcomes for Vancomycin-Resistant Enterococcus Colonization on Intensive Care Unit Admission

PURPOSE: The purpose of this study was to identify vancomycin-resistant enterococcus (VRE) colonization rate in patients admitted to the intensive care unit (ICU), associated risk factors and clinical outcomes for VRE colonization. METHODS: Of the 7,703 patients admitted to the ICUs between January, 2008 and December, 2010, medical records of 554 VRE colonized and 503 uncolonized patients were reviewed retrospectively. To analyzed the impact of colonization on patients' clinical outcomes, 199 VRE colonized patients were matched with 199 uncolonized patients using a propensity score matching method. RESULTS: During the study period, 567 (7.2%) of the 7,703 patients were colonized with VRE. Multivariate analysis identified the following independent risk factors for VRE colonization: use of antibiotics (odds ratio [OR]=3.33), having bedsores (OR=2.92), having invasive devices (OR=2.29), methicillin-resistant Staphylococcus aureus co-colonization (OR=1.84), and previous hospitalization (OR=1.74). VRE colonized patients were more likely to have infectious diseases than uncolonized patients. VRE colonization was associated with prolonged hospitalization and higher mortality. CONCLUSION: Strict infection control program including preemptive isolation for high-risk group may be helpful. Further research needs to be done to investigate the effects of active surveillance program on the incidence of colonization or infection with VRE in the ICU.

Vancomycin-resistant Enterococcus avium Isolated from the Wound of a Patient with Diabetes Mellitus

Enterococcus avium, very commonly found in birds, is rarely reported as a human pathogen. Although several studies have focused on cases of infection with E. avium, little is known about the clinical features of E. avium infection and the antimicrobial susceptibility pattern of E. avium. We isolated vanA-producing vancomycin-resistant E. avium from specimen obtained from the wound of a patient with diabetes mellitus. Vancomycin-resistant E. avium is rarely observed among the vancomycin-resistant enterococci colonizing the intestine, and there are very few reports of vancomycin-resistant E. avium isolated from clinical specimens. Here we confirmed that the clinical isolate was E. avium on the basis of phenotypic characterization and the results of 16S rRNA sequence analysis.

Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital / Sucesso no controle da transmissão hospitalar de Enterococos resistentes a vancomicina em um hospital universitário público brasileiro

INTRODUCTION: Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001). CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.

INTRODUÇÃO: Enterococos resistentes a vancomicina (ERV) podem colonizar e causar infecção em pacientes de alto risco, bem como contaminar o ambiente. Nosso objetivo foi descrever a investigação epidemiológica de um surto de ERV, as intervenções realizadas e o impacto no controle do surto. MÉTODOS: Estudo retrospectivo, descritivo, por revisão de prontuários de pacientes com cultura positiva para ERV em um hospital geral, público, universitário, admitidos entre fevereiro de 2008 e janeiro de 2009. As intervenções foram divididas em ações educacionais, revisão de processos de trabalho, medidas administrativas e de engenharia. RESULTADOS: Foram avaliados 150 pacientes, 139 (92,7%) colonizados e 11 (7,3%) infectados por ERV. Setenta e três por cento estavam internados em unidades de cuidados não intensivos (p=0,028). Infecção por ERV foi mais frequente em pacientes usando cateter venoso central (p=0,043), ventilação mecânica (p=0,013), cateter urinário (p=0,049) ou drenos cirúrgicos (p=0,049). Vancomicina, metronidazol, ciprofloxacina ou cefalosporina de terceira geração foram utilizados previamente por 47 (31,3%), 31 (20,7%), 24 (16%) e 24 (16%) pacientes, respectivamente. Óbito foi mais frequente em pacientes infectados por ERV (73%) em relação aos colonizados (17%) (p<0,001). Após as intervenções, a taxa de ataque diminuiu de 1,49 para 0,33 (p<0,001). CONCLUSÕES: Fatores de risco clássicos para colonização ou infecção por ERV, como internação em unidade de terapia intensiva e uso prévio de vancomicina, não foram identificados neste estudo. Um conjunto de intervenções, tais como programa educacional, maior adesão às precauções de contato e reforço da limpeza ambiental apresentou impacto no controle da disseminação hospitalar do ERV.

Effects of Infection Control Education for Families of VRE Patients / 기본간호학회지

PURPOSE: The purpose of this study was to examine the effects of infection control education for families of patients infected with vancomycin resistant enterococcus (VRE). METHOD: Forty family members of VRE patients were chosen from a university hospital and assigned to the experimental or control group. The experimental group was provided infection control education that consisted of one-on-one instruction using an information booklet, hand-washing video, and demonstration of hand washing practice. Dependent variables were self-reported knowledge and performance of VRE infection control measures, and the number of hand washings when entering and leaving patients' rooms. RESULTS: Knowledge and performance scores were significantly higher for the experimental group compared to the control group. The experimental group washed their hands significantly more often when entering and leaving patients' rooms than the control group. CONCLUSION: Infection control education for family members of VRE patients was effective in improving knowledge and performance of infection control measures as well as improving the practice of hand washing. Further investigation is needed on the effects of infection control education for families on the actual VRE colonization and/or infection rate.