Bacteriologic profile, antibiotics resistance pattern, and outcomes of patients admitted to Lancet General Hospital from June 2022 to June 2023: A retrospective cohort study

Background Prior studies indicated increased antimicrobial resistance in Ethiopia, with related health, economic, and environmental costs. Knowing an institutions and population microbiologic profile allows for proper antibi-otic treatment, which substantially impact patients' outcomes such as healthcare related costs, morbidity, and mortality. The current study assessed the bacteriologic profile, resistance pattern, and treatment outcome in Lancet General Hospital. Method A retrospective cohort study on the bacteriologic profile, antibiotics resistance pattern, and outcome of patients was done on 128 eligible patients who were admitted to Lancet General Hospital from June 2022 to June 2023. Data from all hospitalized patients with culture-confirmed infection were analyzed. SPSS version 26.0 was used to analyze the data. Association between independent and dependent variables was analyzed using binary logistic regression model. Results Gram-negative bacteria were recovered in 77% of the cases. Extended-spectrum beta-lactamase producing Enterobacteriaceae was found in 37.5% (54) isolates and carbapenem resistant bacteria were identified in 27.8% of patients. In-hospital mortality from multidrug resistant bacterial infection was 14.8%. Age ≥ 65 years, presence of septic shock, and presence of carbapenem-resistant bacteria were independently associated with in-creased in-hospital mortality. Conclusion High number of resistant microorganisms was isolated, and increased mortality was documented from infections caused by carbapenem-resistant bacteria. Multi-center studies should be done to determine the extent of resistant organisms in health facilities throughout the country. epidemiology, and the findings should be factored into clinical decision making and program design for disease prevention, screening, and treatment. It also calls for further prospective research to learn more about the conditions in the context of additional relevant personal and clinical characteristics

Factores asociados a colonización por enterococo sp resistente a vancomicina en una unidad de cuidados intensivos pediátricos del Paraguay: estudio transversal sobre historias clínicas / Factors associated with vancomycin-resistant enterococcus colonization in a pediatric intensive care unit of Paraguay: a cross-sectional study on hospital charts

INTRODUCCIÓN Las infecciones por Enterococcus sp resistente a la vancomicina se han diseminado y generan un desafío clínico-terapéutico en los pacientes hospitalizados. La amenaza de que la infección por enterococos intratables y la posibilidad que la resistencia a la vancomicina pueda propagarse a neumococos o estafilococos, abogan por la vigilancia atenta de las cepas resistentes. OBJETIVO Determinar los factores de riesgos asociados a la portación de Enterococcus sp resistente a la vancomicina en pacientes pediátricos ingresados en una unidad de cuidados intensivos pediátricos del Paraguay en el periodo entre enero de 2012 y junio de 2013. MÉTODOS Estudio transversal. Se analizaron las historias clínicas previas de 140 pacientes ingresados a terapia intensiva (niños de un mes a 18 años), a quienes se realizaron cultivos de hisopado rectal dentro de las 48 horas del ingreso, para determinar los factores asociados a la portación de Enterococcus sp resistente a la vancomicina en unidad de cuidados intensivos pediátricos. Se calculó el Odd ratio con sus intervalos de confianza y p < 0,05 para las variables de estudio. Posteriormente, se realizó regresión logística múltiple para las variables estadísticamente significativas. RESULTADOS La portación de Enterococcus sp resistente a la vancomicina se observó en 18,6% de los pacientes. Se identificaron como factores asociados: la hospitalización previa durante el último año (Odds ratio: 10,8; intervalo de confianza 95%: 2,43 a 47,8; p = 0,001), uso previo de antibióticos de amplio espectro (Odds ratio: 5,05; intervalo de confianza 95%: 2,04 a 12,5; p = 0,000), uso de dos o más antibióticos de amplio espectro en el último año (Odds ratio: 5,4; intervalo de confianza 95%: 1,5 a 18,4; p = 0,009), internación previa en área de alto riesgo (Odds ratio: 4,91; intervalo de confianza 95%: 1,83 a 13,2; p = 0,000), internación por igual o mayor a seis días en área de alto riesgo (Odds ratio: 5,64; intervalo de confianza 95%: 2,18 a 14,6; p = 0,000) y uso de inmunosupresores (Odds ratio: 4,84; intervalo de confianza 95%: 1,92 a 11,9; p = 0,001). La regresión múltiple señala a la utilización de dos o más antibióticos de amplio espectro (Odds ratio: 4,81; intervalo de confianza 95%: 1,01 a 22,8; p = 0,047) y a la historia de hospitalización previa dentro del año (Odds ratio: 7,84; intervalo de confianza 95%: 1,24 a 49,32; p = 0,028) como factores independientes asociados estadísticamente con la portación de Enterococcus sp resistente a la vancomicina. CONCLUSIÓN Los pacientes pediátricos ingresados en la unidad de cuidados intensivos con historia de internación previa dentro del año y la exposición a dos o más antibióticos de amplio espectro, tienen mayor riesgo de colonización por el enterococo resistente a vancomicina.

INTRODUCTION Vancomycin-resistant enterococcus (VRE) infections have become widespread and a challenge in hospitalized patients. The threat of infection by intractable enterococci and the possibility that vancomycin resistance could involve pneumococci or staphylococci advocate for careful surveillance of resistant strains. OBJECTIVE To determine the risk factors associated with VRE colonization in pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) in the period between January 2012 and June 2013. METHODS We conducted a cross-sectional study analyzing the clinical histories of 140 patients admitted to the PICU (children from 1 month to 18 years), who underwent rectal swab cultures within 48 hours of admission. We calculated the odds ratios and confidence intervals of the risk factors for VRE colonization in the PICU, and then we used multiple logistic regression for the statistically significant variables. RESULTS VRE colonization was present in 18.6% of patients. The following were identified as risk factors associated to VRE colonization: hospitalization during the previous year (odds ratio: 10.8, 95% confidence interval: 2.43 to 47.8; p = 0.001), prior use of one broad-spectrum antibiotic (odds ratio: 5.05; 95% confidence interval: 2.04 to 12.5; p = 0.000), use of two or more broad-spectrum antibiotics in the last year (odds ratio: 5.4, 95% confidence interval: 1.5 to 18.4; p = 0.009), prior hospitalization in the risk area (odds ratio: 4.91, 95% confidence interval: 1.83 to 13.2; p = 0.000), hospitalization for more than five days in high-risk area (odds ratio: 5.64, 95% confidence interval: 2.18 to 14.6; p = 0.000), and use of immunosuppressant drugs (odds ratio: 4.84, 95% confidence interval: 1.92 to 11.9; p = 0.001). In a logistic multiple regression the use of two or more broad-spectrum antibiotics (odds ratio: 4.81, 95% confidence interval: 1.01 to 22.8; p = 0.047) and the history of prior hospitalization in the last year (odds ratio: 7.84, 95% confidence interval: 1.24 to 49.32, p = 0.028) were identified as independent factors statistically associated with VRE colonization. CONCLUSION Pediatric patients admitted to the Intensive Care Unit with a history of prior hospitalization in the previous year, and exposure to two or more broad-spectrum antibiotics have a greater risk of colonization by vancomycin-resistant enterococcus.

Antimicrobial resistance profile of clinical isolates in hospitals across China: report from the CHINET Surveillance Program, 2017 / 中国感染与化疗杂志

Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five children's hospitals were involved in this program. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.

CHINET surveillance of bacterial resistance across China: report of the results in 2016 / 中国感染与化疗杂志

Objective To investigate the susceptibility profile of clinical isolates collected from hospitals across China.Methods Twenty-six general hospitals and four children's hospitals were involved in this program.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2016 breakpoints.Results A total of 153 059 clinical isolates were collected from Junuary to December 2016,of which gram-negative organisms and gram-positive cocci accounted for 71.6％ and 28.4％,respectively.The overall prevalence of methicillin-resistant strains was 38.4％ in S.aureus (MRSA) and 77.6％ in coagulase negative staphylococcus (MRCNS),respectively.The resistance rates of methicillin-resistant strains to most of other antimicrobial agents were much higher than those of methicillin-susceptible strains.However,92.3％ of the MRSA strains were still sensitive to trimethoprim-sulfamethoxazole,while 86.5％ of the MRCNS strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin or teicoplanin.The resistance rates of E.faecalis strains to most drugs tested (except chloramphenicol) were much lower than those of E.faecium.A few strains of both species were resistant to vancomycin.Vancomycin resistant E.faecalis and E.faecium strains were mainly VanA,VanB or VanM type based on their phenotype or genotype.Regarding the non-meningitis S.pneumoniae strains,the prevalence of PSSP or PISP strains isolated from children was higher than that isolated in 2015,but the prevalence of PRSP strains decreased.However,the prevalence of PISP and PRSP strains isolated from adults was lower than that isolated in 2015.The prevalence of ESBLs-producing strains was 45.2％ in E.coli,25.2％ in Klebsiella spp.(K.pneumoniae and K.oxytoca) and 16.5％ in Proteus mirabilis isolates on average.ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rate.The strains of Enterobacteriaceae were still highly susceptible to carbapenems.Overall,less than 10％ of these strains were resistant to carbapenems.About 68.6％ and 71.4％ ofAcinetobacter spp.(A.baumannii accounts for 90.6％) strains were resistant to imipenem and meropenem,respectively.The prevalence of extensively-drug resistant strains in P.aeruginosa was higher than that in 2015.Conclusions Bacterial resistance to commonly used antibiotics is still on the rise.It is necessary to strengthen hospital infection control and management of clinical use of antimicrobial agents,and maintain good practice in surveillance of bacterial resistance.

Surveillance of antibiotic resistance in the clinical isolates collected from Shanghai Xinhua Hospital Chongming Branch during 2015 / 中国感染与化疗杂志

Objective To analyze the antimicrobial resistance profile of clinical isolates in Shanghai Xinhua Hospital Chongming Branch affiliated to Shanghai Jiaotong University School of Medicine , a member of China Antimicrobial Resistance Surveillance System, during 2015, for the purpose to facilitate rational antimicrobial therapy. Methods Strain identification?and?susceptibility?testing?were?carried?out?for?the?clinical?isolates?using?MicroScan?WalkAway?96?Automated?Systems and Kirby-Bauer method. Results In 2015, a total of 1815 isolates were collected, including gram-negative bacteria (73.2 %) and gram-positive bacteria (26.8 %). The top three frequently isolated species were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. ESBL-producing strains were found in 36.3 % of the Escherichia coli isolates, 12.6 % of the Klebsiella (K. pneumoniae and K. oxytoca) isolates, and 28.0 % of the Proteus mirabilis isolates. The prevalence of carbapenem-resistant strains was 0.69 % in Enterobacteriaceae isolates. The prevalence of methicillin-resistant strain was 29.1 % in S. aureus, and 61.4 % in coagulase-negative Staphylococcus isolates. No more than 15 % of the Enterobacteriaceae isolates and no more than 20 % of the P. aeruginosa and Acinetobacter isolates were resistant to carbapenems. No vancomycin-or linezolid-resistant strains were found in Enterococcus or Staphylococcus. Conclusions Antibiotic-resistant clinical isolates are a serious threat for clinical antimicrobial treatment. We should pay more attention to such urgent situation and rational use of antibiotics.

Distribution and antimicrobial resistance profile of the clinical bacterial strains isolated from Beijing Children's Hospital from 2009 to 2015 / 中国感染与化疗杂志

Objective To investigate the distribution and antimicrobial resistance profile of the common pathogens isolated during the period from 2009 to 2015.Methods All the bacterial strains isolated from pediatric inpatients in Beijing Children's Hospital during the period from 2009 to 2015 were analyzed. Antimicrobial susceptibility was determined by disk diffusion method and Phoenix 100 Automated Microbiology System. Results were analyzed according to the guidelines of CLSI (2014) using WHONET 5.6 software.Results The total strains were 26630. The most common gram-positive isolates were Streptococcus pneumoniae,Staphylococcusaureusand coagulase-negative Staphylococcus (CNS), while the most frequently isolated gram-negative microorganisms were Klebsiella spp.,Pseudomonas aeruginosa and Escherichia coli. The prevalence of S. pneumoniae was up to 25.7 % (4101/15973) in all respiratory tract specimens. About 50.2 % of the S. pneumoniae isolates were not susceptible to penicillin. The prevalence of methicillin-resistant strains was 20.6 % in S. aureus (MRSA) and 87.8 % in coagulase negative Staphylococcus (MRCNS) on average. The prevalence of MRSA increased from 11.1 % in 2009 to 29.8 % in 2015. No S. pneumoniae or staphylococcal strains were found resistant to vancomycin or linezolid. The Enterococcus strains were still highly susceptible to vancomycin and linezolid. Overall 0.3 % of the Enterococcus faecium isolates were resistant to vancomycin. The extended-spectrum beta-lactamases (ESBLs) producing strains accounted for 71.4 % -78.1 % of E. coli and 65.1 % - 76.9 % of K. pneumoniae isolates. The carbapenem-resistant E. coli and K. pneumoniae were reported for the first time in 2010, but in 2014, the strains resistant to carbapenems had increased to more than 7 % in E. coli, and higher than 20 % in K. pneumoniae. In 2015, up to 27.7 % and 25.7 % of P. aeruginosa isolates were resistant to imipenem and meropenem, respectively, and 59.9 % of the A. baumannii isolates were resistant to imipenem and meropenem. Beta-lactamase was positive in 46.3 % of the H. influenzae isolates. Conclusions MRSA and the carbapenem-resistant strains of E. coli,K. pneumoniae and A. baumannii are still on the rise in pediatric inpatients, which poses a serious threat to clinical practice and implies the importance of strengthening infection control.

Análisis de mortalidad debida a una infección del torrente sanguíneo por Enterococcus faecium en Taiwán central / Mortality analysis of Enterococcus faecium bloodstream infection in central Taiwan

Background: Bloodstream infections (BSIs) due to Enterococcus faecium (E. faecium), particularly those due to vancomycin-resistant enterococcus (VRE), are still a therapeutic challenge. Aim: To evaluate mortality from BSI due to E. faecium and VRE in central Taiwan. Materials and Methods: We retrospectively analyzed cases of significant E. faecium BSI in the Changhua Christian Hospital System between January 1, 2010 and December 31, 2013. Results: Of the 76 cases, 28 patients (36.8%) were admitted to intensive care units (ICUs) at the onset of BSI, 10 (13.2%) cases were associated with polymicrobial bacteremia, and 29 (38.2%) cases were associated with entry via the biliary tract. VRE was observed in 18 (23.7%) cases. The 30-day mortality rate was 13.1% (10/76). Multivariate logistic regression analysis showed that bacteremia of non-biliary tract origin (OR = 8.43, 95% confidence interval (95% CI) = 1.32-54.00, p = 0.002) and ICU admission (OR = 4.2, 95% CI = 1.7-10.0, p = 0.002) were significant risk factors for 30-day mortality, whereas appropriate antimicrobial therapy was a protective factor for 30-day mortality (OR = 0.33, 95% CI = 0.14-0.79, p = 0.013). Conclusions: Our results underscore the need to assist patients admitted to ICUs with E. faecium BSIs with a non-biliary tract origin. We emphasize the use of appropriate antimicrobial therapy for E. faecium BSI with the aim to rescue more patients with these infections.

Antecedentes: Las infecciones del torrente sanguíneo por Enterococcus faecium, particularmente aquellas causadas por enterococos resistentes a vancomicina (ERV), representan aún un desafío para los tratamientos. Este estudio está orientado a la evaluación de la mortalidad debido a la infección del torrente sanguíneo (ITS) por E. faecium y por enterococos resistentes a vancomicina (ERV) en Taiwán central. Materiales y Métodos: Analizamos de forma retrospectiva casos de ITS causadas por E. faecium genuinas en el Sistema del Hospital Changhua Christian, entre los días 1 de enero de 2010 y 31 de diciembre de 2013. Resultados: De los 76 casos analizados, 28 pacientes fueron ingresados a las Unidades de Cuidados Intensivos (UCI) al comienzo de una ITS (36,8%), 10 casos fueron asociados a bacteriemia polimicrobiana (13,2%), y 29 casos tuvieron como puerta de entrada la vía biliar. En 18 casos se pudieron observar ERV (23,7%). La mortalidad a 30 días fue de 13,1% (10/76). El análisis multivariado mediante regresión logística mostró que la bacteriemia de origen no biliar (OR = 8,43, 95% intervalo de confianza (95% CI) = 1,32-54,00; p = 0,002), y el ingreso a la UCI (OR = 4,2; 95% CI = 1,7-10,0; p = 0,002), fueron factores de riesgo significativos para el rango de mortalidad de 30 días, así como un tratamiento de antimicrobiano apropiado constituye un factor protector en contra la mortalidad (OR = 0,33; 95% CI = 0,14-0,79; p = 0,013). Conclusiones: Nuestros resultados destacan la necesidad de asistir a los pacientes ingresados a la UCI con ITS por E. faecium con origen no biliar. Hacemos énfasis a la aplicación de una antibioterapia adecuada para sacar adelante a un mayor número de pacientes con este tipo de infecciones.

Factores de riesgo de colonización por Enterococcus spp resistente a vancomicina en pacientes pediátricos hospitalizados con patología oncológica / Risk factor of intestinal colonization with vancomycin resistant Enterococcus spp in hospitalized pediatric patients with oncological disease

Background: The isolation of vancomycin-resistant Enterococcus spp (ERV) has increased significantly within the last few years, along with the risk of infection and dissemination of these bacteria. Our aim was to determine risk factors (RF) for intestinal colonization in hospitalized pediatric patients with oncological disease at Hospital de Niños Roberto del Río. Methods: Between January 2012 and December 2013 a transversal study was performed with 107 rectal swabs and processed with a PCR for ERV. The patients were classified as "colonized with ERV" and "not colonized with ERV" and we evaluated possible RF for intestinal colonization in both groups. Results: VRE colonization was found in 51 patients (52%). The median of time elapsed between oncological diagnosis and VRE colonization was 35 days. The significant RF associated with VRE colonization were days of hospitalization prior to study, neutropenia and treatment with antibiotics within 30 days prior to study and mucositis. Conclusions: According to the RF revealed in this study we may suggest prevention standards to avoid ERV colonization. This is the first investigation in our country in hospitalized pediatric patients with oncological disease and processed with a multiplex PCR for ERV, therefore it is a great contribution about this subject in Chile.

Introducción: El aislamiento de Enterococcus spp resistentes a vancomicina (ERV) ha presentado un incremento significativo en los últimos años, aumentando el riesgo de infección por esta bacteria y favoreciendo su diseminación. Nuestro objetivo es determinar los factores de riesgo (FR) de colonización intestinal de ERV en pacientes oncológicos internados en el Hospital de Niños Roberto del Río. Método: Entre enero de 2012 y diciembre de 2013 se realizó un estudio transversal de colonización rectal por ERV mediante muestras de hisopado rectal obtenidas en 107 pacientes efectuando RPC múltiple para ERV. Se dividió en grupo "portador" y "no portador" y se evaluó los posibles FR para colonización por ERV. Resultados: Se encontró colonización por ERV en 51 pacientes (52%). El tiempo transcurrido desde el diagnóstico oncológico y la colonización presentó una mediana de 35 días. Los FR encontrados con asociación significativa fueron el número de días de hospitalización previa, neutropenia, uso de antimicrobianos 30 días previos y mucositis. Conclusión: De acuerdo a los FR encontrados podemos sugerir medidas de prevención para colonización por ERV. Esta es la primera investigación realizada en nuestro país en pacientes oncológicos pediátricos y que utiliza la técnica de RPC múltiple para ERV, lo que permite un aporte significativo sobre este tema en Chile.

Risk of vancomycin-resistant enterococci bloodstream infection among patients colonized with vancomycin-resistant enterococci

Background: Vancomycin-resistant enterococci colonization has been reported to increase the risk of developing infections, including bloodstream infections. Aim: In this study, we aimed to share our experience with the vancomycin-resistant enterococci bloodstream infections following gastrointestinal vancomycin-resistant enterococci colonization in pediatric population during a period of 18 months. Method: A retrospective cohort of children admitted to a 400-bed tertiary teaching hospital in Izmir, Turkey whose vancomycin-resistant enterococci colonization was newly detected during routine surveillances for gastrointestinal vancomycin-resistant enterococci colonization during the period of January 2009 and December 2012 were included in this study. All vancomycin-resistant enterococci isolates found within 18 months after initial detection were evaluated for evidence of infection. Findings: Two hundred and sixteen patients with vancomycin-resistant enterococci were included in the study. Vancomycin-resistant enterococci colonization was detected in 136 patients (62.3%) while they were hospitalized at intensive care units; while the remaining majority (33.0%) were hospitalized at hematology-oncology department. Vancomycinresistant enterococci bacteremia was present only in three (1.55%) patients. All these patients were immunosuppressed due to human immunodeficiency virus (one patient) and intensive chemotherapy (two patients). Conclusion: In conclusion, our study found that 1.55% of vancomycin-resistant enterococcicolonized children had developed vancomycin-resistant enterococci bloodstream infection among the pediatric intensive care unit and hematology/oncology patients; according to our findings, we suggest that immunosupression is the key point for developing vancomycinresistant enterococci bloodstream infections. .

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.

Multidrug-Resistant Gram-Positive Bacterial Infections / 대한내과학회지

Antimicrobial resistance threatens the effective treatment of bacterial infections and is a serious problem worldwide. Multidrug-resistant bacteria are difficult to treat and the treatment outcome is worse than with susceptible bacteria. In Korea, the antibiotic resistance rates of the major Gram-positive bacteria methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and penicillin-resistant Streptococcus pneumoniae (PRSP) are very high. Clinicians should know the risk factors for developing multidrug-resistant bacterial infection, update the changing local epidemiology of resistant bacteria, and choose appropriate antibiotics in clinical practice. The overuse and misuse of broad spectrum antibiotics should be avoided. This review focuses on the epidemiology and risk factors of MRSA, VRE, and PRSP, the major multidrug-resistant Gram-positive bacteria.

Influence Factors for Duration of Vancomycin Resistant Enterococci's Spontaneous Decolonization

PURPOSE: The aim of this study was to identify the factors influencing the spontaneous decolonization period of vancomycin resistant enterococcus (VRE) species in pediatric patients. METHODS: The medical records of patients presenting positive VRE cultures between January 2005 and November 2010 at a tertiary hospital in Seoul, Korea, were reviewed retrospectively. The subjects were divided into two groups according to the average number of days for decolonization (325 days). Clinical characteristics were compared between shorter VRE colonization patients (325 days, n=110). RESULTS: There were 151 patients who had more than 1 year of follow up period or confirmed of VRE decolonization among patients who were identified with VRE. The average age at the time of initial VRE colonization was significantly younger in shorter decolonization group than in prolonged decolonization group (44.9 months vs 40.9 months, P=0.040). The prolonged decolonization group received more vancomycin treatments after VRE colonization in comparison with patients in shorter decolonization group (7.0% vs 27.2%, P=0.008). CONCLUSIONS: For the duration of VRE colonization, it was found that the initial age of acquiring VRE and use of antibiotics were important factors. Antibiotics should be used properly and precisely in order to treat infectious diseases and to control the colonization of antibiotic resistant bacteria.

Epidemiology and Molecular Characterization of Vancomycin-Resistant Enterococcus faecalis / 대한임상미생물학회지

BACKGROUND: Vancomycin-resistant Enterococci (VRE) infections are caused by Enterococcus faecium in about 90% of the cases but can also be caused by Enterococcus faecalis. Thus, this study investigates factors that cause a low isolation rate of vancomycin-resistant E. faecalis (VREfs). To this end, the authors study the clinical traits, resistant gene structure, genomic classification, and molecular characteristics of the virulent factor. METHODS: From January 2001 through September 2011, 17 vanA-containing E. faecalis isolates were collected from hospitalized patients at Ajou University Hospital in Korea. Identification, antimicrobial susceptibility testing, and PCR of van and esp genes were performed. Pulsed-field gel electrophoresis (PFGE) was used for strain typing. PCR and sequencing of the internal regions of Tn1546 were performed for structural analysis of the van gene. RESULTS: Of 4,235 VRE infections, 3,918 (92.5%) were caused by E. faecium, and 95 (2.2%) were caused by E. faecalis. In 67% of VREfs infections, there was a preceding occurrence of E. faecium infection. All isolates were of genotype vanA. Our isolates were divided into three types according to the distribution of IS elements integrated into Tn1546 (types I to IIb). The PFGE results showed no clonal relatedness among isolates. CONCLUSION: Our study found that VREfs infections affect patients who have experienced vancomycin-resistant E. faecium. (VREfm) infection or undergo invasive procedures. The VREfs seems to involve the horizontal transfer of Tn1546 transposon from VREfm.

Refractory Clostridium difficile Infection Cured With Fecal Microbiota Transplantation in Vancomycin-Resistant Enterococcus Colonized Patient

The rates and severity of Clostridium difficile infections, including pseudomembranous colitis, have increased markedly. However, there are few effective treatments for refractory or recurrent C. difficile infections and the outcomes are poor. Fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. Cure rates of >90% are being consistently reported from multiple centers. We cured a case of severe refractory C. difficile infection with fecal microbiota transplantation in a patient colonized by vancomycin-resistant enterococcus.

Risk factors of bloodstream infections caused by vancomycin-resistant Enterococcus / 中国感染与化疗杂志

Objective To analyze the bloodstream infections caused by vancomycin‐resistant Enterococcus (VRE)in West China Hospital and examine the risk factors of such infections for best control of VRE infections .Methods Case‐control method was used to compare the bloodstream infections due to VRE with those caused by vancomycin‐susceptible Enterococcus(VSE)from August 2010 to August 2014 in West China Hospital .The data were compared by T‐test ,Chi‐square test (univariate analysis) and logistic regression analysis (multivariate analysis) using SPSS 19 .0 software .Results A total of 31 VRE strains were isolated from bloodstream infections in the study period ,including 5 (16 .1 % ) strains of vancomycin‐resistant Enterococcus faecalis and 26 (83 .9 % )strains of vancomycin‐resistant Enterococcus faecium .In the past four years ,the prevalence of vancomycin‐resistant E . f aecalis in bloodstream infections was 1 .5% ,1 .6% ,1 .8% ,and 1 .2% ;while the prevalence of vancomycin‐resistant E . f aecium in bloodstream infections was 3 .8% ,4 .4% ,5 .8% ,and 7 .1% .Such VRE bloodstream infection was mainly found in Intensive Care Unit (ICU)(13 ,41 .9% )and Department of Neurosurgery (4 ,12 .9% ) .More than 90% of the isolates were resistant to ampicillin and erythromycin .But less than 20% of the strains were resistant to quinupristin‐dalfopristin and linezolid . Univariate analysis indicated that prolonged hospital stay , ICU admission , venous catheter ,prior carbapenem exposure , prior vancomycin/norvancomycin exposure were associated with VRE bloodstream infections .Logistic regression analysis confirmed that venous catheter was an independent risk factor of VRE bloodstream infections .Conclusions Venous catheter is an independent risk factor for VRE bloodstream infections . Infection control measures should be strengthened to prevent the outbreak of VRE‐related bloodstream infections .

Vancomycin‑resistant Enterococcus faecium: Report of two cases.

Vancomycin‑resistant Enterococci (VRE), especially Enterococcus faecium has emerged as an important nososcomial pathogen and represents a serious threat to patients with impaired host defense. Early detection of patients colonised or infected with VRE is an essential component of any hospital program designed to prevent nosocomial transmission of this organism. The authors report two cases of VRE isolated from blood and surgical site pus of two neonates admitted in the same neonatal unit, highlighting that early detection, prompt and appropriate infection control measures were keys to successful containment of this dreaded pathogen.

Analysis of distribution and drug resistance of Enterococcus faecium / 中国医师进修杂志

Objective To investigate the distribution and drug resistance ofEnterococcus faecium,provide evidence for clinical rational use of antimicrobial agents.Methods Retrospective analysis of drug resistance of Enterococcus faecium,summarize the specimen type,distribution of departments and so on,to explore the trend of drug resistance.Results Enterococcus faecium to vancomycin resistance rate from 3.54％ (4/113) in 2010,rose to 8.45％ (18/213) in 2013.One strains of hnezolid resistant Enterococcus faecium 717 was found,the minimum inhibitory concentration of 7.9 mg/L,not tigecycline resistance in Enterococcus faecium found.Conclusion Vancomycin resistant Enterococcus faecium for linezolid and tigecycline susceptibility is still high,the two kinds of antimicrobial agents can be used for the treatment of vancomycin resistant Enterococcus faecium.

Vancomycin resistant Enterococcus spp (VRE): follow up during 9 years in a tertiary teaching hospital in southern Brazil

Introduction: Infection with vancomycin-resistant Enterococcus spp (VRE) has been a worldwide problem since mid 1980’s and, in Brazil, since 1996. This study was conducted to evaluate the experience with VRE in our institution. Methods: A prospective cohort study from 2000 to 2009 was conducted at Hospital São Lucas da PUCRS. All hospitalized patients with VRE positive culture were included and followed from their diagnosis until they were negative for VRE or their discharge. Only the first admission for each VRE positive patient was included. Pulsed field gel electrophoresis (PFGE) was performed to determine how VRE had spread. Results: A total of 315 cases of VRE were identified, 224 of which were isolated from rectal swabs. Vancomycin-resistant/ampicilin susceptible Enterococcus faecalis were identified in 312 isolates. PFGE was performed in 47 VRE isolates that presented an indistinguishable migratory profile. The median length of hospital stay and length of stay before VRE isolation were 46 days and 21 days, respectively; 52% of the patients were aged 60 and above. The annual distribution of the new VRE cases showed a clear decrease from 2000 to 2009. Discussion: This study shows a substantial VRE colonization (71%) with a homogenous pattern that emphasizes its transversal spread. Predominance of E. faecalis differs from the literature which largely describes a higher prevalence of vancomycin-resistant Enterococcus faecium. The follow up of VRE during 9 years in our institution highlighted the importance of continuous surveillance to prevent outbreaks in our hospital.

Emergence and characterisation of vanB vancomycin-resistant Enterococcus faecalis in Rio de Janeiro, Brazil

Here we describe the detection and characterisation of three isolates of vancomycin-resistant VanB-type Enterococcus faecalis. Sequence analysis suggested that these isolates harboured the vanB1 gene. The isolates were susceptible to the majority of antimicrobial agents tested, with the exception of chloramphenicol, erythromycin and vancomycin, and showed distinct profiles of high-level resistance to aminoglycosides. Analysis of the clonal relatedness of the vanB E. faecalis isolates showed similar pulsed-field gel electrophoresis profiles. To our knowledge, this is the first report of the occurrence of enterococcal strains carrying vanB genes in Brazil.

Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention

The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE) outbreak in a tertiary-care pediatric intensive care unit (PICU) of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75 percent reduction), and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.