101
|
Abstract
Broth formulations of two media selective for enterococci, Enterococcel, M-Enterococcosel broths were supplemented with 6 micrograms of vancomycin per ml and evaluated for isolation of vancomycin-resistant enterococci (VRE). Each broth was challenged with various concentrations of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and vancomycin-susceptible and vancomycin-resistant enterococci and with 193 perianal specimens obtained from patients at risk in our institution for VRE colonization. Both the Enterococcosel and M-Enterococcus broths with vancomycin detected as few as 1 to 9 CFU of VRE while inhibiting growth of the other organisms tested. Enterococcus faecium organisms (MIC, > 256 micrograms/ml) were recovered from 66 perianal swab cultures in the enterococcosel-vancomycin broth, and VRE were recovered from 62 perianal swab cultures in the M-Enterococcus-vancomycin broth. Enterococcosel-vancomycin broth detected VRE in perianal specimens 48 h earlier than did M-Enterococcus-vancomycin broth. Enterococcosel broth with 6 micrograms of vancomycin per ml can be used for the rapid and selective isolation of VRE from surveillance specimens.
Collapse
Affiliation(s)
- K G van Horn
- Department of Clinical Pathology, Westchester County Medical Center, Valhalla, New York 10595, USA
| | | | | |
Collapse
|
102
|
Affiliation(s)
- Constanze Wendt
- Institute of Hygiene, Benjamin Franklin University Clinic of the Berlin FU, National Reference Center for Hospital Hygiene, Berlin, Germany; and
| | | |
Collapse
|
103
|
Moulin F, Dumontier S, Saulnier P, Chachaty E, Loubeyre C, Brugières L, Andremont A. Surveillance of intestinal colonization and of infection by vancomycin-resistant enterococci in hospitalized cancer patients. Clin Microbiol Infect 1996; 2:192-201. [PMID: 11866843 DOI: 10.1016/s1198-743x(14)65142-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE: To study epidemiologic features of and risk factors for intestinal colonization and infection by vancomycin-resistant enterococci (VRE) in cancer patients. METHODS: During a 41-month period, over 7600 fecal samples and all samples from sterile sites from hospitalized cancer patients were screened for VRE. Species were identified and isolates analyzed by pulsed-field gel electrophoresis (PFGE) of SmaI DNA restriction fragments. Antibiotic resistance was characterized by MIC determinations, and polymerase chain reaction for vanA, vanB, and vanC1 genes. Plasmid contents were analyzed before and after PstI and HindIII restriction, and by Southern hybridization with a vanA probe. Two case-control studies were performed to identify risk factors for colonization or infection by VRE, respectively. RESULTS: Eighty-two isolates were recovered from 81 patients. Most (72%) isolates were Enterococcus faecium VanA/vanA, with 37 different PFGE types, each of which was found in only one to four patients, except for type P1, which was found in 20 patients hospitalized over a 3-month period in the pediatric wards. Plasmid analysis suggested that only two types of plasmid were carrying gene vanA, as part of a transposon related to transposon Tn 1546 from reference strain E. faecium BM4147. Seventy-seven patients were colonized during the study period. Six of them became infected. Four patients were infected but not colonized. Only one patient died during the course of infection, but intestinal colonization persisted for months in the survivors. Case-control analysis revealed that cephalosporin treatment was a significant risk factor for colonization. No significant risk factor for infection was found in colonized patients. CONCLUSION: Colonization by VRE was mostly endemic and the colonized patients were not often infected. However, when clustered cases of colonization occurred, they were then associated with an increased rate of infection.
Collapse
Affiliation(s)
- Florence Moulin
- Service de Microbiologie Médicale, Institut Gustave-Roussy, Villejuif, France
| | | | | | | | | | | | | |
Collapse
|
104
|
Rao GG, Ghanekar K, Ojo F. Selective medium for screening for vancomycin-resistant enterococci in faeces. Eur J Clin Microbiol Infect Dis 1996; 15:175-7. [PMID: 8801094 DOI: 10.1007/bf01591495] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Infections caused by vancomycin-resistant enterococci (VRE) are becoming increasingly prevalent throughout the world. Control measures include detection and isolation of carriers of VRE. A selective medium to detect faecal carriage of VRE is described. The medium has a high productivity ratio (90.4%) for VRE with VanA resistance phenotype, a moderate productivity ratio (79.2%) for VRE with VanB resistance phenotype, and a relatively low productivity ratio (65.5%) for VRE with VanC resistance phenotype. There was no breakthrough of vancomycin-susceptible enterococci. The medium selected the growth of all three types of VRE, which were used to spike faecal specimens. In a limited clinical trial, six faecal specimens of carriers and contacts were screened using the selective medium. Vancomycin-resistant enterococci (Enterococcus faecalis, VanA phenotype) were detected in four of the specimens. In all four specimens the growth of VRE was nearly pure and easily identifiable.
Collapse
Affiliation(s)
- G G Rao
- Lewisham Hospital, NHS Trust, London, UK
| | | | | |
Collapse
|
105
|
Weinstein JW, Tallapragada S, Farrel P, Dembry LM. Comparison of rectal and perirectal swabs for detection of colonization with vancomycin-resistant enterococci. J Clin Microbiol 1996; 34:210-2. [PMID: 8748308 PMCID: PMC228765 DOI: 10.1128/jcm.34.1.210-212.1996] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Patients whose gastrointestinal tracts are colonized with vancomycin-resistant enterococci (VRE) may serve as a reservoir for nosocomial transmission. We compared the sensitivities and concordance of several methods used to detect VRE colonization. Eighty-two paired rectal and perirectal swabs were obtained from 13 patients over a 9-day period. The sensitivity of both rectal and perirectal swabs was 79%. There was 100% concordance of culture results between simultaneously obtained rectal and perirectal swabs, and the quantities of growth were similar by these two methods of detection. Our data suggest that rectal and perirectal swabs are equally sensitive for the detection of VRE colonization.
Collapse
Affiliation(s)
- J W Weinstein
- Department of Infection Control and Hospital Epidemiology, Yale-New Haven Hospital, Connecticut 06504, USA
| | | | | | | |
Collapse
|
106
|
Weinstein JW, Roe M, Towns M, Sanders L, Thorpe JJ, Corey GR, Sexton DJ. Resistant Enterococci: A Prospective Study of Prevalence, Incidence, and Factors Associated with Colonization in a University Hospital. Infect Control Hosp Epidemiol 1996. [DOI: 10.2307/30142363] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
107
|
|
108
|
Montecalvo MA, de Lencastre H, Carraher M, Gedris C, Chung M, VanHorn K, Wormser GP. Natural History of Colonization with Vancoimycin-Resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1995. [DOI: 10.2307/30141910] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
109
|
Boyce JM. Vancomycin-Resistant Enterococci: Pervasive and Persistent Pathogens. Infect Control Hosp Epidemiol 1995. [DOI: 10.2307/30141909] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
110
|
|
111
|
Noskin GA, Stosor V, Cooper I, Peterson LR. Recovery of Vancomycin-Resistant Enterococci on Fingertips and Environmental Surfaces. Infect Control Hosp Epidemiol 1995. [DOI: 10.2307/30141097] [Citation(s) in RCA: 140] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
112
|
Woodford N, Johnson AP, Morrison D, Speller DC. Current perspectives on glycopeptide resistance. Clin Microbiol Rev 1995; 8:585-615. [PMID: 8665471 PMCID: PMC172877 DOI: 10.1128/cmr.8.4.585] [Citation(s) in RCA: 215] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In the last 5 years, clinical isolates of gram-positive bacteria with intrinsic or acquired resistance to glycopeptide antibiotics have been encountered increasingly. In many of these isolates, resistance arises from an alteration of the antibiotic target site, with the terminal D-alanyl-D-alanine moiety of peptidoglycan precursors being replaced by groups that do not bind glycopeptides. Although the criteria for defining resistance have been revised frequently, the reliable detection of low-level glycopeptide resistance remains problematic and is influenced by the method chosen. Glycopeptide-resistant enterococci have emerged as a particular problem in hospitals, where in addition to sporadic cases, clusters of infections with evidence of interpatient spread have occurred. Studies using molecular typing methods have implicated colonization of patients, staff carriage, and environmental contamination in the dissemination of these bacteria. Choice of antimicrobial therapy for infections caused by glycopeptide-resistant bacteria may be complicated by resistance to other antibiotics. Severe therapeutic difficulties are being encountered among patients infected with enterococci, with some infections being untreatable with currently available antibiotics.
Collapse
Affiliation(s)
- N Woodford
- Antibiotic Reference Unit, Central Public Health Laboratory, London, England
| | | | | | | |
Collapse
|
113
|
Affiliation(s)
- David C.E. Speller
- Department of Infectious Diseases and Bacteriology, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | | | | |
Collapse
|
114
|
Abstract
Enterococci are nosocomial pathogens intrinsically resistant to a variety of commonly used antimicrobial agents. The frequent use of antimicrobial agents such as cephalosporins has been associated with the increased isolation of enterococci in pediatric hospitals. In addition to their intrinsic resistance traits, the enterococci have rapidly accumulated a variety of acquired resistance determinants. Strains that are resistant to all currently available antibiotics are now being isolated from infected children. The threat of untreatable enterococcal infection and the possibility that vancomycin resistance may spread from the enterococci to the more virulent pneumococci or staphylococci argue for vigilant surveillance for resistant strains, isolation and barrier precautions for infected patients, increased research into the mechanisms of resistance, and a reinvigorated effort to identify new classes of antimicrobial agents.
Collapse
Affiliation(s)
- L B Rice
- Infectious Diseases Section, Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | | |
Collapse
|
115
|
Shay DK, Goldmann DA, Jarvis WR. Reducing the spread of antimicrobial-resistant microorganisms. Control of vancomycin-resistant enterococci. Pediatr Clin North Am 1995; 42:703-16. [PMID: 7761148 DOI: 10.1016/s0031-3955(16)38986-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Strategies to reduce the spread of hospital-acquired microorganisms resistant to multiple antimicrobial agents are discussed. Because hospitals have experienced a rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) in the past 5 years, the Hospital Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention has issued recommendations for preventing the spread of vancomycin resistance. Controlling VRE dissemination in pediatric patients requires prompt detection of VRE by microbiology laboratories, education of staff and families about VRE, use of infection control measures to prevent person-to-person VRE transmission, and prudent vancomycin use.
Collapse
Affiliation(s)
- D K Shay
- National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | |
Collapse
|
116
|
Recommendations for Preventing the Spread of Vancomycin Resistance. Infect Control Hosp Epidemiol 1995. [DOI: 10.2307/30140952] [Citation(s) in RCA: 266] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
117
|
Chenoweth CE, Bradley SF, Terpenning MS, Zarins LT, Ramsey MA, Schaberg DR, Kauffman CA. Colonization and transmission of high-level gentamicin-resistant enterococci in a long-term care facility. Infect Control Hosp Epidemiol 1994; 15:703-9. [PMID: 7852726 DOI: 10.1086/646841] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess the prevalence of high-level gentamicin-resistant enterococcus (HGRE) colonization, transmission patterns, and spectrum of illness among residents of a long-term care facility. DESIGN Monthly surveillance for HGRE colonization of wounds, rectum, and perineum over a 1-year period. SETTING A Veterans Affairs long-term care facility attached to an acute-care facility. PATIENTS All 341 patients in the facility during the observation period. RESULTS Over the 1-year period, 120 patients (35.2%) were colonized with HGRE at least once, with an overall monthly colonization rate of 20 +/- 1.5%. HGRE were isolated from rectum (12.8%), wounds (11.7%), and perineum (9.3%). Patients with the poorest functional status had the highest rate of colonization (P < 0.0005). HGRE-colonized patients were more likely to be colonized with methicillin-resistant Staphylococcus aureus (51% versus 25%; P < 0.0005). Seventy-four patients (21.7%) were colonized at admission or at the start of the study. Another 46 patients (13.5%) acquired HGRE during the study, including 36 who acquired HGRE while in the long-term care facility and 10 who were positive when transferred back from the acute-care hospital. Based on plasmid profiles, only two patients appeared to have isolates similar to those of current or previous roommates. Carriage of HGRE was transient in most cases. Only 20 patients were colonized for 4 or more months, and those patients usually carried different strains intermittently. Infections were infrequent, occurring in only 4.1% of total patients. CONCLUSIONS In our long-term care facility, HGRE were endemic, and new acquisition of HGRE occurred frequently. However, only two patients had evidence of acquisition from a roommate, suggesting that cross-infection from a roommate was not a major route of spread of HGRE.
Collapse
Affiliation(s)
- C E Chenoweth
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | | | | | | | | | | | | |
Collapse
|
118
|
Chenoweth CE, Bradley SF, Terpenning MS, Zarins LT, Ramsey MA, Schaberg DR, Kauffman CA. Colonization and Transmission of High-Level Gentamicin-Resistant Enterococci in a Long-Term Care Facility. Infect Control Hosp Epidemiol 1994. [DOI: 10.2307/30148336] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
119
|
Willey BM, McGeer AJ, Ostrowski MA, Kreiswirth BN, Low DE. The Use of Molecular Typing Techniques in the Epidemiologic Investigation of Resistant Enterococci. Infect Control Hosp Epidemiol 1994. [DOI: 10.2307/30148408] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
120
|
Boyce JM, Opal SM, Chow JW, Zervos MJ, Potter-Bynoe G, Sherman CB, Romulo RL, Fortna S, Medeiros AA. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994; 32:1148-53. [PMID: 8051238 PMCID: PMC263627 DOI: 10.1128/jcm.32.5.1148-1153.1994] [Citation(s) in RCA: 353] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Enterococcus faecium strains resistant to ampicillin, high levels of gentamicin, and vancomycin but susceptible to teicoplanin (vanB class vancomycin resistance) were recovered from 37 patients during an outbreak involving a 250-bed university-affiliated hospital. Three isolates with vancomycin MICs ranging from 8 to 256 micrograms/ml all hybridized with a vanB probe. Restriction endonuclease analysis of chromosomal and plasmid DNA suggested that all isolates tested were derived from a single clone. Vancomycin resistance was shown to be transferable. Risk factors for acquiring the epidemic strain included proximity to another case patient (P, 0.0005) and exposure to a nurse who cared for another case patient (P, 0.007). Contamination of the environment by the epidemic strain occurred significantly more often when case patients had diarrhea (P, 0.001). Placing patients in private rooms and requiring the use of gowns as well as gloves by personnel controlled the outbreak. These findings suggest that multidrug-resistant E. faecium strains with transferable vanB class vancomycin resistance will emerge as important nosocomial pathogens. Because extensive environmental contamination may occur when affected patients develop diarrhea, barrier precautions, including the use of both gowns and gloves, should be implemented as soon as these pathogens are encountered.
Collapse
Affiliation(s)
- J M Boyce
- Department of Medicine, Miriam Hospital, Providence, RI 02906
| | | | | | | | | | | | | | | | | |
Collapse
|
121
|
Chow JW, Kuritza A, Shlaes DM, Green M, Sahm DF, Zervos MJ. Clonal spread of vancomycin-resistant Enterococcus faecium between patients in three hospitals in two states. J Clin Microbiol 1993; 31:1609-11. [PMID: 8315004 PMCID: PMC265587 DOI: 10.1128/jcm.31.6.1609-1611.1993] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The DNAs of 3* vancomycin-resistant Enterococcus faecium isolates from five hospitals in three states were analyzed by contour-clamped homogeneous electric field electrophoresis and plasmid analysis. There were 22 strain types. One strain type was common to patients in three hospitals in two states. These results suggest the apparent intra- and interhospital spread of vancomycin-resistant E. faecium.
Collapse
Affiliation(s)
- J W Chow
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan 48201
| | | | | | | | | | | |
Collapse
|
122
|
Goldmann DA. Vancomycin-Resistant Enterococcus faecium: Headline News. Infect Control Hosp Epidemiol 1992. [DOI: 10.2307/30146485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
123
|
Boyce JM. Methicillin-Resistant Staphylococcus aureus in Hospitals and Long-Term Care Facilities: Microbiology, Epidemiology, and Preventive Measures. Infect Control Hosp Epidemiol 1992. [DOI: 10.2307/30146490] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
124
|
Abstract
The synthesis of large numbers of antibiotics over the past three decades has caused complacency about the threat of bacterial resistance. Bacteria have become resistant to antimicrobial agents as a result of chromosomal changes or the exchange of the exchange of genetic material via plasmids and transposons. Streptococcus pneumoniae, Streptococcus pyogenes, and staphylococci, organisms that cause respiratory and cutaneous infections, and members of the Enterobacteriaceae and Pseudomonas families, organisms that cause diarrhea, urinary infection, and sepsis, are now resistant to virtually all of the older antibiotics. The extensive use of antibiotics in the community and hospitals has fueled this crisis. Mechanisms such as antibiotic control programs, better hygiene, and synthesis of agents with improved antimicrobial activity need to be adopted in order to limit bacterial resistance.
Collapse
Affiliation(s)
- H C Neu
- College of Physicians & Surgeons, Columbia University, New York, NY 10032
| |
Collapse
|
125
|
|