Estudio de factores de riesgo para colonización por enterococo resistente a vancomicina en el Hospital Militar de Santiago / Risk factors associated to vancomycin-resistant enterococccus colonization in the Army Hospital in Santiago

Since the appearance of Vancomicin-resistant enterococci (VRE) in our country, the Chilean Ministry of Health recommended the surveillance of intestinal colonization in patients in critical wards. We report the results of surveillance in ICU and onco-hematological wards from 2002 to 2008, with analysis of possible risk factors: demographical data, use and type of antibiotic, days of hospitalization prior to sampling, and year of hospitaliza-tion. Colonization rate increased from 0.03 cases per lOOObed-days in2003 to 0.18 cases during2008. Univariate analysis identified 7 risk factors associated with ERV colonization: hospitalization in ICU, use of antibiotics, use of 3 or more compounds, use of imipenem or colistin, > 10 days of hospitalization prior to the study and year of hospitalization ( before 2007 or after). Multivariate analysis by logistic binary regression showed that only the last two: >10 days of hospitalization prior to the study and year of hospitalization (before 2007 or after), were significantly associated to colonization by ERV.

Desde la emergencia de Enterococcus resistente a vancomicina (ERV) en Chile, el Ministerio de Salud recomendó la vigilancia de colonización intestinal por ERV en pacientes hospitalizados en unidades de pacientes críticos. Describimos los resultados de vigilancia en UCI y Unidad de Aislamiento de Pacientes Hemato-oncológicos desde 2002 a 2008, analizando probables factores de riesgo: datos demográficos, uso y tipo de antimicrobiano, días de hospitalización previo a la toma de muestra y año de hospitalización. La tasa de colonización aumentó de 0,03 casos por 1000 días cama en 2003 a 0,18 durante 2008. El análisis univariado permitió identificar siete factores asociados al riesgo de colonización por ERV: hospitalización en UCI, uso previo o actual de antimicrobianos, haber recibido tres o más antibióticos, terapia con imipenem o colistin, más de 10 días de hospitalización y el año de hospitalización. El análisis multivariado mediante regresión logística binaria, señaló la duración de la hospitalización hasta el momento del estudio (> 10 días) y el año de hospitalización (2007 o después) como factores significativamente asociados al riesgo de colonización por ERV.

Emergencia de infecciones por Enterococcus sp resistente a vancomicina en un hospital universitario en Chile / Emergency of vancomycm-vesistant Enterococcus infections in a teaching hospital in Chile

Introducción. En Chile, se desarrolla una vigilancia activa de portación intestinal de Enterococcus resistente a vancomicina (ERV) desde el año 2000. Sin embargo, no hay publicaciones sobre casos clínicos. Objetivo: Describir casos de infección por ERV en un hospital de nivel terciario. Pacientes y Método: Se obtuvieron de los registros del laboratorio las muestras clínicas o intestinales positivas para ERV (2001 al 2006) y se analizaron en los pacientes afectados los factores de riesgo potenciales, manifestaciones clínicas, tratamiento y evolución. Resultados: Se identificaron 23 casos (tasa de incidencia año 2005 de 0,07 y año 2006 de 0,09/1.000 días camas ocupadas). El promedio de edad fue 62,0 ± 17 años. Antecedentes: cáncer (39,l por cientoo), procedimientos quirúrgicos recientes (54,1 por ciento), hemodiálisis (26,1 por ciento), corticoterapia (26,1 por ciento). El 87 por cientoo había recibido dos o más antimicrobianos, casi un tercio fue transferido desde otros hospitales y 22 por ciento había reingresado antes de 30 días. Los pacientes habían estado principalmente en UCI (60,9 por ciento), el resto en salas nefrológicas u onco-hematológicas. Los cuadros clínicos incluyeron bacteriemias (30,4 por ciento), infecciones del sitio quirúrgico o abscesos (26,1 por ciento), infecciones urinarias (26,1 por ciento) u otros. Tres pacientes fueron asintomáticos (13 por ciento). Los aislados fueron identificados como E. faecium en 82,6 por cientoo del total, el resto como Enterococcus sp. El 66,7 por cientoo de las cepas mostró susceptibilidad intermedia a vancomicina. En 14 cepas con estudio completo para vancomicina y teicoplanina, predominó el fenotipo VanB (85,7 por ciento), seguido de los fenotipos VanA (7,1 por ciento) y VanB/VanD (7,1 por ciento). Quince pacientes fueron tratados en forma médica o médico-quirúrgica, hubo respuesta favorable en 80 por cientoo de ellos. Ocho pacientes no recibieron tratamiento (34,8 por ciento), en dos...

An active surveillance of vancomycin-resistant enterococci (VRE) intestinal colonization in selected group of patients has been developed in Chile since year 2000. Nevertheless, no reports of clinical cases have been published. Aim. To describe main clinical and microbiological features of patients infected by VRE in a tertiary-level teaching Hospital. Patients and methods. Intestinal and clinical samples positive to VRE were provided by laboratory, and a retrospective analysis of potential risk factors, clinical features, treatment and outcomes was performed. Study encompassed years 2001 to 2006. Main results. 23 cases of infections were identified, all cases occurring during 2005 and 2006. Incidence rate was 0.07 and 0.09 cases per 1000 occupied bed-days, respectively. The mean age was 62.0 ± 17 years. A significant proportion of patients had cancer (39.1 percent), recent surgical procedures (54.1 percent), were on dialysis (26.1 percent), or were using steroids (26.1 percent). Most patients had received 2 or more antimicrobial (87 percent), almost a third represented transfers from other hospitals and an additional 22 percent readmissions before 30 days of latest discharge. Patients were mainly hospitalized in the ICU (60.9 percent) but nearly 30 percent were associated exclusively to nephrological or onco-hematological wards. Clinical manifestations included bacteremia (30.4 percent), surgical site infections or abscesses (26.1 percent), urinary tract infections (26.1 percent) and others. . Three patients (13 percent) did not have symptoms. After identification was possible, all isolates were identified as E. faecium (82.6 percent of total), the rest as Enterococcus sp. Most strains showed intermediate susceptibility to vancomycin (66.7 percent). For 14 strains studied both with vancomycin and teicoplanin, , phenotype Van B was predominant (85.7 percent), followed by VanA (7.1 percent) and VanB/VanD type (7.1 percent). No molecular...

Intestinal Colonization of Vancomycin-Resistant Enterococci / 병원감염관리

BACKGROUND: In the United States, the Centers for Disease Control and Prevention recorded a 20-fold increase in the incidence of vancomycin-resistant enterococci (VRE) associated with nosocomial infections between 1989 and 1991. Although VRE has been reported in Korea since 1992, infections caused by these organisms are still extremely rare in Pusan, Korea. Therefore, a point prevalence culture survey was carried out to investigate the prevalence of intestinal colonization with VRE among patients admitted to Kosin Medical Center, which can predict the appearance of clinical infections with VRE. METHODS: Between July 1997 and August 1997, stool specimens were obtained from 303 patients. Specimens were placed in bile esculin azide broth containing vancomycin (64 microgram/mL) and aatreonam (60 microgram/mL). Cultures were done for 48 hours at 37degrees C, and turbid solutions were subcultured on blood agar. Minimal inhibitory concentrations (MIC) of vancomycin and teicoplanin to Enterococcus isolates were determined by Etest on Mueller-Hinton agar. For amplification of the vanA, vanB, and vanC genes, polymerase chain reactions were performed. RESULTS: VRE isolates were isolated from 6 of the patients (2%). Four of them were identified as E. faecium, and 1 was identified as E. avium, and 1 was identified as Enterococcus spp. All of them were highly resistant to vancomycin (MICs >256 microgram/mL), and they were also resistant to teicoplanin (MICs 32-->256 microgram/mL). All of 6 VRE strains carried vanA gene. CONCLUSION: The colonization of VRE was not infrequent among the patients of a university hospital in Pusan, Korea. Moreover, a large proportion of the colonizing VRE was revealed Enterococcus faecium with vanA gene, which implies quite a possibility of a sudden rising of infections by this organism in the near future. So we propose that the vancomycin susceptibility test should be done for every enterococcal isolate from clinical specimens and the intestinal colonization rate of VRE should be closely monitored at regular intervals for the purpose of surveillance 50 that proper establishment of plans for the prevention of this troublesome pathogen's spread can be promptly made.