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Collingwood A, Blostein F, Seekatz AM, Wobus CE, Woods RJ, Foxman B, Bachman MA. Epidemiological and Microbiome Associations Between Klebsiella pneumoniae and Vancomycin-Resistant Enterococcus Colonization in Intensive Care Unit Patients. Open Forum Infect Dis 2020; 7:ofaa012. [PMID: 32010736 PMCID: PMC6984673 DOI: 10.1093/ofid/ofaa012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background Prior colonization by Klebsiella pneumoniae and vancomycin-resistant Enterococci (VRE) is associated with subsequent infection, particularly in intensive care unit (ICU) populations. Screening for VRE colonization, but not K. pneumoniae, is routinely performed in some health care systems. Identification of patient factors associated with K. pneumoniae colonization could enable infection prevention. Methods ICU patients were screened for VRE and K. pneumoniae by rectal swab culture over 2 time periods: July–October 2014 (n = 1209) and January–May 2016 (n = 1243). Patient demographics, baseline laboratory data, comorbidities, and outcomes were analyzed. 16S rRNA gene-based analysis was performed on a subset of patients (n = 248) to identify microbiota characteristics associated with VRE and K. pneumoniae colonization. Results K. pneumoniae colonization (17.3% of patients in the 2014 cohort, 7.3% in 2016) was significantly associated with VRE colonization in multivariable analysis (P = .03 in 2016; P = .08 in 2014). VRE colonization was associated with poor underlying health, whereas K. pneumoniae colonization was associated with advanced age. The most prevalent operational taxonomic units were Escherichia coli/Shigella spp., Klebsiella, and Enterococcus, consistent with high rates of detectable K. pneumoniae and VRE by culture. Microbial community structure in noncolonized patients was significantly different from those with VRE, K. pneumoniae, or both, attributable to differences in the relative abundance of Klebsiella and Enterococcus. Conclusions K. pneumoniae co-colonizes with VRE and is a predominant taxon in ICU patients, but colonization was not associated with significant comorbidities. Screening for K. pneumoniae and VRE simultaneously could be an efficient approach for novel infection prevention strategies.
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Affiliation(s)
| | - Freida Blostein
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Anna M Seekatz
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Christiane E Wobus
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert J Woods
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Betsy Foxman
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Michael A Bachman
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
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Comparison of surveillance and clinical cultures to measure the impact of infection control interventions on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in the hospital. Infect Control Hosp Epidemiol 2020; 41:161-165. [PMID: 31896372 DOI: 10.1017/ice.2019.322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate whether clinical cultures are an appropriate surrogate for surveillance cultures to measure the effect of interventions on the incidence of MRSA and VRE in the hospital. DESIGN Cross-sectional and quasi-experimental, retrospective analysis. SETTING AND POPULATION Convenience sample of patients admitted between January 1, 2002, and June 31, 2011, to the medical intensive care unit (MICU) and surgical intensive care unit (SICU) of an acute-care hospital in the United States. INTERVENTIONS Asynchronously in the MICU and SICU, we introduced (1) universal glove and gown use, (2) bundled intervention to prevent central-line-associated bloodstream infection, and (3) daily chlorhexidine gluconate bathing. RESULTS We observed a statistically significant correlation between surveillance and clinical culture-based incidence rates of MRSA in the MICU (0.32; P < .001) and the SICU (0.37; P < .001) but not for VRE in either the MICU (0.16, P = .11) or the SICU (0.15; P = .12). For VRE, but not for MRSA, incidence density rates based on surveillance cultures were 2- to 4-fold higher than for clinical cultures. When evaluating the impacts of the interventions, different effect estimates were noted for universal glove and gown use on MRSA acquisition in MICU, and for VRE acquisition in both the MICU and the SICU based on surveillance versus clinical cultures. CONCLUSIONS For multidrug-resistant organism acquisition, surveillance cultures should be used when feasible because clinical cultures may not be an appropriate surrogate. Clinical or surveillance-based end points for infection control interventions should reflect the conceptual model from colonization to infection and where an intervention might have an effect, rather than considering them interchangeable.
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Beier RC, Harvey RB, Poole TL, Hume ME, Crippen TL, Highfield LD, Alali WQ, Andrews K, Anderson RC, Nisbet DJ. Interactions of organic acids with vancomycin-resistant Enterococcus faecium isolated from community wastewater in Texas. J Appl Microbiol 2018; 126:480-488. [PMID: 30383327 DOI: 10.1111/jam.14145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/30/2022]
Abstract
AIMS Investigate the interactions of organic acids (OAs), acetic, butyric, citric, formic, lactic and propionic acid against 50 Gram-positive vancomycin-resistant Enterococcus faecium (VRE) strains to determine whether pH, undissociated or dissociated acid forms correlate with bacterial inhibition. METHODS AND RESULTS Concentrations of undissociated and dissociated OAs at the molar minimum inhibitory concentrations (MICM s) of the VRE were calculated using the Henderson-Hasselbalch equation. The pH at the MICM s of all VRE strains against acetic, butyric, formic and propionic acids was similar, 4·66 ± 0·07, but there was a 1·1 pH unit difference for all six OAs. Inhibition of VRE by all six OAs did not appear to be solely dependent on pH or on the undissociated OA species. The inhibition of VRE by all six dissociated acids was within Δ = 3·1 mmol l-1 . CONCLUSIONS Vancomycin-resistant Enterococcus faecium inhibition correlated with the dissociated OA species. A small decrease in the concentration of the dissociated OAs from optimum may result in allowing VRE strains to escape disinfection. SIGNIFICANCE AND IMPACT OF THE STUDY When an OA is used to disinfect VRE strains, the concentration of the dissociated OA should be carefully controlled. A concentration of at least 20 mmol l-1 dissociated OA should be maintained when disinfecting VRE.
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Affiliation(s)
- R C Beier
- Food and Feed Safety Research Unit, United States Department of Agriculture, Agricultural Research Service, Southern Plains Agricultural Research Center, College Station, TX, USA
| | - R B Harvey
- Food and Feed Safety Research Unit, United States Department of Agriculture, Agricultural Research Service, Southern Plains Agricultural Research Center, College Station, TX, USA
| | - T L Poole
- Food and Feed Safety Research Unit, United States Department of Agriculture, Agricultural Research Service, Southern Plains Agricultural Research Center, College Station, TX, USA
| | - M E Hume
- Food and Feed Safety Research Unit, United States Department of Agriculture, Agricultural Research Service, Southern Plains Agricultural Research Center, College Station, TX, USA
| | - T L Crippen
- Food and Feed Safety Research Unit, United States Department of Agriculture, Agricultural Research Service, Southern Plains Agricultural Research Center, College Station, TX, USA
| | | | - W Q Alali
- Department of Veterinary Medicine, College of Food and Agriculture, United Arab Emirates University, Al Ain, United Arab Emirates
| | - K Andrews
- Food and Feed Safety Research Unit, United States Department of Agriculture, Agricultural Research Service, Southern Plains Agricultural Research Center, College Station, TX, USA
| | - R C Anderson
- Food and Feed Safety Research Unit, United States Department of Agriculture, Agricultural Research Service, Southern Plains Agricultural Research Center, College Station, TX, USA
| | - D J Nisbet
- Food and Feed Safety Research Unit, United States Department of Agriculture, Agricultural Research Service, Southern Plains Agricultural Research Center, College Station, TX, USA
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Cheah ALY, Cheng AC, Spelman D, Nation RL, Kong DCM, McBryde ES. Mathematical modelling of vancomycin-resistant enterococci transmission during passive surveillance and active surveillance with contact isolation highlights the need to identify and address the source of acquisition. BMC Infect Dis 2018; 18:511. [PMID: 30309313 PMCID: PMC6182842 DOI: 10.1186/s12879-018-3388-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 09/17/2018] [Indexed: 01/14/2023] Open
Abstract
Background Clinical studies and mathematical simulation suggest that active surveillance with contact isolation is associated with reduced vancomycin-resistant enterococci (VRE) prevalence compared to passive surveillance. Models using pre- and post-intervention data that account for the imperfect observation and serial dependence of VRE transmission events can better estimate the effectiveness of active surveillance and subsequent contact isolation; however, such analyses have not been performed. Methods A mathematical model was fitted to surveillance data collected pre- and post-implementation of active surveillance with contact isolation in the haematology-oncology ward. We developed a Hidden Markov Model to describe undetected and observed VRE colonisation/infection status based on the detection activities in the ward. Bayesian inference was used to estimate transmission rates. The effectiveness of active surveillance was assumed to be via increased detection and subsequent contact isolation of VRE positive patients. Results We estimated that 31% (95% credible interval: 0.33–85%) of the VRE transmissions were due to cross-transmission between patients. The ratio of transmission rates from patients with contact isolation versus those without contact isolation was 0.33 (95% credible interval: 0.050–1.22). Conclusions The majority of the VRE acquisitions in the haematology-oncology ward was estimated to be due to background rates of VRE, rather than within ward patient to patient acquisition. The credible interval for cross-transmission was wide which results in a large degree of uncertainty in the estimates. Factors that could account for background VRE acquisition include endogenous acquisition from antibiotic selection pressure and VRE in the environment. Contact isolation was not significantly associated with reduced VRE transmission in settings where the majority of VRE acquisition was due to background acquisition, emphasising the need to identify and address the source of acquisition. As the credible interval for the ratio of VRE transmission in contact isolated versus non-contact isolated patients crossed 1, there is a probability that the transmission rate in contact isolation was not lower. Our finding highlights the need to optimise infection control measures other than active surveillance for VRE and subsequent contact isolation to reduce VRE transmission. Such measures could include antimicrobial stewardship, environmental cleaning, and hand hygiene. Electronic supplementary material The online version of this article (10.1186/s12879-018-3388-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Agnes Loo Yee Cheah
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia.,Department of Infectious Diseases, Alfred Health, Prahran, VIC, Australia
| | - Allen C Cheng
- Department of Infectious Diseases, Alfred Health, Prahran, VIC, Australia.,Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Prahran, VIC, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Denis Spelman
- Department of Infectious Diseases, Alfred Health, Prahran, VIC, Australia.,Microbiology Unit, Alfred Health, Prahran, VIC, Australia.,Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - Roger L Nation
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - David C M Kong
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia. .,Pharmacy Department, Ballarat Health Services, Ballarat Central, VIC, Australia. .,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Emma S McBryde
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia. .,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
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Priyadharshini SRE, Ramalingam C, Ramesh B. Superintendence of antimicrobial resistance observed in bacterial flora isolated from human faecal carriage in Vellore, India. Saudi J Biol Sci 2018; 24:1679-1688. [PMID: 30294235 PMCID: PMC6169512 DOI: 10.1016/j.sjbs.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/12/2015] [Accepted: 11/17/2015] [Indexed: 11/17/2022] Open
Abstract
A frequent cross-sectional study was conducted to determine the patterns of antimicrobial resistance in 296 bacterial strains isolated from in-patient faecal samples of Government Vellore Medical College and Hospital, Vellore. Isolation and identification of bacterial strains were done using enrichment media, selective media, and biochemical tests. Antimicrobial susceptibility testing by the disc diffusion method and minimal inhibitory concentration method was conducted and the strains were subjected to extended spectrum beta-lactamases screening. Antibiotic sensitivity pattern of Staphylococcus spp. showed oxacillin resistance. Almost all the strains were sensitive to linezolid, vancomycin, gentamycin and chloramphenicol. In gram negative isolates ciprofloxacin and tobramycin showed better sensitivity and ceftazidime showed a higher percentage of resistance by MIC. Out of 250 isolates, Enterobacteriaceae showed positive for 86/250, 82/250 and 94/250 isolates and 3/10, 4/10 and 4/10 non-Enterobacteriaceae isolates were found to be positive for CTX-M gene, TEM gene and SHV gene, respectively. This study helps to assess/analyse the relation between the spectrum of microorganisms present in various grades of faecal carriage and their susceptibility pattern in this part of the Vellore town.
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Affiliation(s)
| | - Chidamabram Ramalingam
- School of Biosciences and Technology (SBST), Vellore Institute of Technology (VIT), Vellore, India
| | - Balasubramanian Ramesh
- Department of Biotechnology, Sri Sankara Arts and Science College, Enathur, Kanchipuram, India
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Hygienemaßnahmen zur Prävention der Infektion durch Enterokokken mit speziellen Antibiotikaresistenzen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1310-1361. [DOI: 10.1007/s00103-018-2811-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Almagor J, Temkin E, Benenson I, Fallach N, Carmeli Y. The impact of antibiotic use on transmission of resistant bacteria in hospitals: Insights from an agent-based model. PLoS One 2018; 13:e0197111. [PMID: 29758063 PMCID: PMC5951570 DOI: 10.1371/journal.pone.0197111] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/26/2018] [Indexed: 12/15/2022] Open
Abstract
Extensive antibiotic use over the years has led to the emergence and spread of antibiotic resistant bacteria (ARB). Antibiotic resistance poses a major threat to public health since for many infections antibiotic treatment is no longer effective. Hospitals are focal points for ARB spread. Antibiotic use in hospitals exerts selective pressure, accelerating the spread of ARB. We used an agent-based model to explore the impact of antibiotics on the transmission dynamics and to examine the potential of stewardship interventions in limiting ARB spread in a hospital. Agents in the model consist of patients and health care workers (HCW). The transmission of ARB occurs through contacts between patients and HCW and between adjacent patients. In the model, antibiotic use affects the risk of transmission by increasing the vulnerability of susceptible patients and the contagiousness of colonized patients who are treated with antibiotics. The model shows that increasing the proportion of patients receiving antibiotics increases the rate of acquisition non-linearly. The effect of antibiotics on the spread of resistance depends on characteristics of the antibiotic agent and the density of antibiotic use. Antibiotic's impact on the spread increases when the bacterial strain is more transmissible, and decreases as resistance prevalence rises. The individual risk for acquiring ARB increases in parallel with antibiotic density both for patients treated and not treated with antibiotics. Antibiotic treatment in the hospital setting plays an important role in determining the spread of resistance. Interventions to limit antibiotic use have the potential to reduce the spread of resistance, mainly by choosing an agent with a favorable profile in terms of its impact on patient's vulnerability and contagiousness. Methods to measure these impacts of antibiotics should be developed, standardized, and incorporated into drug development programs and approval packages.
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Affiliation(s)
- Jonatan Almagor
- Laboratory of Geosimulation and Spatial Analysis, Department of Geography and Human Environment, Tel Aviv University, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- * E-mail:
| | - Elizabeth Temkin
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Itzhak Benenson
- Laboratory of Geosimulation and Spatial Analysis, Department of Geography and Human Environment, Tel Aviv University, Tel Aviv, Israel
| | - Noga Fallach
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yehuda Carmeli
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Munigala S, McMullen KM, Russo AJ, Jafarzadeh SR, Hoppe-Bauer J, Burnham CAD, Warren DK. Reinstatement of Reflex Testing of Stool Samples for Vancomycin-Resistant Enterococci (VRE) Resulted in Decreased Incidence of Hospital-Associated VRE. Infect Control Hosp Epidemiol 2017; 38:619-621. [PMID: 28219459 PMCID: PMC5412709 DOI: 10.1017/ice.2017.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Re-institution of reflex testing of stool submitted for Clostridium difficile testing for vancomycin-resistant enterococci (VRE) reduced the incidence of healthcare-associated VRE bacteremia and bacteriuria compared to when testing was not in place (1.9 versus 3.3 cases per 10,000 patient days when testing was not in use).
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Affiliation(s)
- Satish Munigala
- Division of Infectious Diseases, Washington University in Saint Louis, Missouri USA
| | - Kathleen M. McMullen
- Christian Hospital Department of Infection Prevention, Saint Louis, Missouri, USA
| | - Anthony J. Russo
- Barnes-Jewish Hospital, Infection Prevention Department, Saint Louis, Missouri, USA
| | - S. Reza Jafarzadeh
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joan Hoppe-Bauer
- Clinical Microbiology Laboratory, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Carey-Ann D. Burnham
- Department of Pathology & Immunology, Division of Laboratory and Genomic Medicine, Washington University in Saint Louis, Missouri USA
| | - David K. Warren
- Division of Infectious Diseases, Washington University in Saint Louis, Missouri USA
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Temporal trends and risk factors for healthcare-associated vancomycin-resistant enterococci in adults. J Hosp Infect 2016; 94:236-241. [PMID: 27645212 DOI: 10.1016/j.jhin.2016.07.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/31/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Published data regarding temporal trends in vancomycin-resistant enterococci (VRE) prevalence within specific regions or healthcare systems are scarce. AIM To characterize temporal trends and risk factors for healthcare-associated infections caused by VRE. METHODS The study included all adult discharges occurring from 2006 to 2014 with an enterococcal infection from three hospitals in a large academic healthcare system. Bivariate analyses were used to identify statistically significant factors associated with vancomycin-susceptible or -resistant infection. Statistically significant variables were included in a final logistic regression model. Trends assessed whether the proportion of enterococcal infections resistant to vancomycin changed over time. FINDINGS The sample included 10,186 adults with first-time healthcare-associated enterococcal infection. Significant risk factors (P≤0.05) for VRE in the final logistic regression model included: tertiary 1 hospital, intensive care unit length of stay, higher Charlson Comorbidity Index, previous immunosuppressive or chemotherapeutic medications, previous hospitalization, renal failure, malignancy, longer length of stay prior to infection, taking an antibiotic prior to infection, being female, and having an infection in winter or spring. Between 2006 and 2014, the rate of resistance varied from 37.1 to 42.9% but there were no significant differences in the proportion resistant to vancomycin over time (P=0.36). CONCLUSION Research targeted at risk factors is important to decrease the amount of VRE infections.
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Muto CA. Why Are Antibiotic-Resistant Nosocomial Infections Spiraling Out of Control? Infect Control Hosp Epidemiol 2016; 26:10-2. [PMID: 15693403 DOI: 10.1086/502481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sunenshine RH, Liedtke LA, Fridkin SK, Strausbaugh LJ. Management of Inpatients Colonized or Infected With Antimicrobial-Resistant Bacteria in Hospitals in the United States. Infect Control Hosp Epidemiol 2016; 26:138-43. [PMID: 15756883 DOI: 10.1086/502517] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractBackground:Although guidelines for multidrug-resistant organisms generally include recommendations for contact precautions and surveillance cultures, it is not known how frequently U.S. hospitals implement these measures on a routine basis and whether infectious diseases consultants endorse their use.Methods:The Emerging Infections Network surveyed its members, infectious diseases consultants, to assess their use of and support for contact precautions and surveillance cultures for routine management of multidrug-resistant organisms in their principal inpatient workplace. Specifically, members were asked about use of these strategies for methicillin-resistantStaphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant, gram-negative bacilli on general wards, ICUs, and transplant units.Results:Overall, 400 (86%) of 463 respondents supported the routine use of contact precautions to control one or more multidrug-resistant organisms in at least one unit, and 89% worked in hospitals that use them. In contrast, 50% of respondents favored routine use of surveillance cultures to manage at least one multidrug-resistant organism in any unit, and 30% of respondents worked in hospitals that use them routinely in any unit. Members favored routine use of surveillance cultures significantly more in ICUs and transplant units than in general wards for each multidrug-resistant organism (P<.001).Conclusions:Most of the infectious diseases consultants endorsed the use of contact precautions for routine management of patients colonized or infected with multidrug-resistant organisms and work in hospitals that have implemented them. In contrast, infectious diseases consultants are divided about the role of routine surveillance cultures in multidrug-resistant organism management, and few work in hospitals that use them.
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Affiliation(s)
- Rebecca H Sunenshine
- Division of Infectious Diseases, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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12
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Singh N, Léger MM, Campbell J, Short B, Campos JM. Control of Vancomycin-Resistant Enterococci in the Neonatal Intensive Care Unit. Infect Control Hosp Epidemiol 2016; 26:646-9. [PMID: 16092746 DOI: 10.1086/502595] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractBackground and Objective:Multidrug-resistant organisms (MDROs), such as vancomycin-resistant enterococci (VRE), cause serious infections, especially among high-risk patients in NICUs. When VRE was introduced and transmitted in our NICU despite recommended infection control practices, we instituted active surveillance cultures to determine their efficacy in detecting and controlling spread of VRE among high-risk infants.Methods:Active surveillance cultures, other infection control measures, and a mandatory in-service education module on preventing MDRO transmission were implemented. Cultures were performed on NICU admission and then weekly during their stay. Molecular DNA fingerprinting of VRE isolates facilitated targeting efforts to eliminate clonal spread of VRE. Repetitive sequence PCR (rep-PCR)-based DNA fingerprinting was used to compare isolates recovered from patients with VRE infection or colonization. Environmental VRE cultures were performed around VRE-colonized or -infected patients. DNA fingerprints were prepared from the products of rep-PCR amplification and analyzed using software to determine strain genetic relatedness.Results:Active surveillance cultures identified 65 patients with VRE colonization or infection among 1,820 admitted to the NICU. Rep-PCR performed on 60 VRE isolates identified 3 clusters. Cluster 1 included isolates from 21 patients and 4 isolates from the environment of the index patient. Clusters 2 and 3 included isolates from 23 and 3 patients, respectively. Similarity coefficients among the members of each cluster were 95% or greater.Conclusions:Control of transmission of multi-clonal VRE strains was achieved. Active surveillance cultures, together with implementation of other infection control measures, combined with rep-PCR DNA fingerprinting were instrumental in controlling VRE transmission in our NICU. (Infect Control Hosp Epidemiol 2005;26:646-649)
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Affiliation(s)
- Nalini Singh
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC 20010, USA.
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Ryan L, O'Mahony E, Wrenn C, FitzGerald S, Fox U, Boyle B, Schaffer K, Werner G, Klare I. Epidemiology and molecular typing of VRE bloodstream isolates in an Irish tertiary care hospital. J Antimicrob Chemother 2015; 70:2718-24. [PMID: 26142479 DOI: 10.1093/jac/dkv185] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 06/10/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Ireland has the highest rate of vancomycin-resistant Enterococcus faecium (VREfm) isolated from blood of nosocomial patients in Europe, which rose from 33% (110/330) in 2007 to 45% (178/392) in 2012. No other European country had a VREfm rate from blood cultures of >25%. Our aim was to elucidate the reasons for this significantly higher rate in Ireland. METHODS The epidemiology and molecular typing of VRE from bloodstream infections (BSIs) was examined in a tertiary care referral hospital and isolates were compared with those from other tertiary care referral centres in the region. RESULTS The most common source of VRE BSIs was intra-abdominal sepsis, followed by line-related infection and febrile neutropenia. Most of the isolates were positive for vanA; 52% (43/83) possessed the esp gene and 12% (10/83) possessed the hyl gene. Genotyping by SmaI macrorestriction analysis (PFGE) of isolates revealed clonal relatedness between bloodstream isolates and environmental isolates. VRE BSI isolates from two other tertiary care hospitals in the Dublin region showed relatedness by PFGE analysis. MLST revealed four STs (ST17, ST18, ST78 and ST203), all belonging to the clonal complex of hospital-associated strains. CONCLUSIONS Irish VRE BSI isolates have virulence factor profiles as previously reported from Europe. Typing analysis shows the spread of individual clones within the hospital and between regional tertiary care hospitals. Apart from transmission of VRE within the hospital and transfer of colonized patients between Irish hospitals, no other explanation for the persistently high VREfm BSI rate in Ireland has been found.
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Affiliation(s)
- L Ryan
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E O'Mahony
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - C Wrenn
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S FitzGerald
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - U Fox
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - B Boyle
- Department of Clinical Microbiology, St James's Hospital, Dublin 8, Ireland
| | - K Schaffer
- Department of Clinical Microbiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - G Werner
- German National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - I Klare
- German National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
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Song JY, Cheong HJ, Seo YB, Kim IS, Heo JY, Noh JY, Choi WS, Kim WJ. Clinical and microbiological characteristics of vancomycin-resistant enterococci with the VanD phenotype and vanA genotype. Jpn J Infect Dis 2015; 66:1-5. [PMID: 23429076 DOI: 10.7883/yoken.66.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vancomycin-resistant enterococci (VRE) strains with the VanD phenotype and vanA genotype (VanD-vanA) have been reported in Asian countries. The VanD phenotype is characterized by low-level resistance to vancomycin and susceptibility or intermediate resistance to teicoplanin. We retrospectively determined the risk factors, clinical outcomes, and virulence factors for VanD-vanA VRE (20 patients colonized with Enterococcus faecium) compared to VanA-vanA VRE (20 patients colonized with E. faecium). Multiple VRE colonizations and recent glycopeptide use were related to the presence of the VanA phenotype. There were no significant differences between patients colonized with VanD-vanA VRE and VanA-vanA VRE for duration of hospital stay, duration of intensive care unit stay, or hospital mortality. The esp gene was identified from all enterococci, while 90% of VanD-vanA VRE isolates and 95% of VanA-vanA VRE isolates were positive for the hyl gene. VanA-vanA VRE was subsequently isolated from sequential samples in 8 of 20 patients (40%) with VanD-vanA VRE. All of these patients had received glycopeptides during the interval between sample collection, and 2 of 8 paired isolates (VanD-vanA VRE and VanA-vanA VRE) were closely related subtypes according to pulsed-field gel electrophoresis analysis. In conclusion, VanD-vanA VRE isolates might represent an unstable, heterogeneous population that can convert to the VanA phenotype after exposure to glycopeptides.
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Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Axon RN, Engemann JJ, Butcher J, Lockamy K, Kaye KS. Control of Nosocomial Acquisition of Vancomycin-ResistantEnterococcusThrough Active Surveillance of Hemodialysis Patients. Infect Control Hosp Epidemiol 2015; 25:436-8. [PMID: 15188852 DOI: 10.1086/502419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractHemodialysis-dependent patients are an important VRE source. After implementation of active surveillance for VRE targeting hemodialysis patients, the hospital-wide nosocomial VRE rate increased by 41%, but decreased by 41% among non-hemodialysis patients (P= .05). To assess the effectiveness of active surveillance, patients undergoing active surveillance should be analyzed separately from other patients.
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Affiliation(s)
- R Neal Axon
- Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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Farr BM. Political Versus Epidemiological Correctness. Infect Control Hosp Epidemiol 2015; 28:589-93. [PMID: 17464920 DOI: 10.1086/515710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 02/20/2007] [Indexed: 01/08/2023]
Abstract
In the March issue of the journal, the Joint SHEA and APIC Task Force indicates that the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC) support the use of active detection and isolation (ADI) for controlling nosocomial infections due to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) “in appropriate circumstances, as recommended in previously published guidelines”1(p250) (those published by SHEA and the Healthcare Infection Control Practices Advisory Committee [HICPAC]), but that SHEA and APIC oppose the use of legislation for mandating any infection control approach, including this one as tried in 2006 in Illinois and Maryland.
Both supporters and opponents of controlling MRSA and VRE with ADI probably will agree that legislation is not the optimal way to control nosocomial infections in general, but this position statement undoubtedly will please the latter more than it does the former because the SHEA/APIC Task Force argues that ADI is not ready for routine use throughout all healthcare facilities, directly opposing the position of the original SHEA guideline. As an author of that SHEA guideline, I would like to comment. First, the new position seems politically correct (since most infection control professionals have not yet bothered using ADI to control MRSA and VRE), but many of the planks of the SHEA/APIC Task Force position statement are misleading.
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Affiliation(s)
- Barry M Farr
- University of Virginia Health System, Charlottesville, VA 22908, USA.
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Weber SG, Huang SS, Oriola S, Huskins WC, Noskin GA, Harriman K, Olmsted RN, Bonten M, Lundstrom T, Climo MW, Roghmann MC, Murphy CL, Karchmer TB. Legislative Mandates for Use of Active Surveillance Cultures to Screen for Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci: Position Statement From the Joint SHEA and APIC Task Force. Infect Control Hosp Epidemiol 2015; 28:249-60. [PMID: 17326014 DOI: 10.1086/512261] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 01/05/2007] [Indexed: 01/14/2023]
Abstract
Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association of Professionals in Infection Control and Epidemiology (APIC) have developed this joint position statement. Both organizations are dedicated to combating healthcare-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, APIC and SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) SHEA and APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) APIC and SHEA welcome efforts by healthcare consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare-associated infections. (4) SHEA and APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) APIC and SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.
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Affiliation(s)
- Stephen G Weber
- Section of Infectious Diseases, University of Chicago, Chicago, IL 60637, USA.
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Milstone AM, Maragakis LL, Carroll KC, Perl TM. Targeted Surveillance to Identify Children Colonized with Vancomycin-Resistant Enterococcus in the Pediatric Intensive Care Unit. Infect Control Hosp Epidemiol 2015; 31:95-8. [DOI: 10.1086/649221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Performing admission surveillance cultures is a resource-intensive strategy to identify asymptomatic patients with vancomycin-resistant Enterococcus (VRE) colonization. We measured VRE prevalence among children admitted to the pediatric intensive care unit. Targeted surveillance captured 94% of VRE-colonized children and may be an effective strategy to identify VRE carriers and facilitate pediatric infection prevention strategies.
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Abstract
It is critical for health care personnel to recognize and appreciate the detrimental impact of intensive care unit (ICU)-acquired infections. The economic, clinical, and social expenses to patients and hospitals are overwhelming. To limit the incidence of ICU-acquired infections, aggressive infection control measures must be implemented and enforced. Researchers and national committees have developed and continue to develop evidence-based guidelines to control ICU infections. A multifaceted approach, including infection prevention committees, antimicrobial stewardship programs, daily reassessments-intervention bundles, identifying and minimizing risk factors, and continuing staff education programs, is essential. Infection control in the ICU is an evolving area of critical care research.
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Affiliation(s)
- Mohamed F Osman
- Division of Trauma/Burns and Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, MA 02115, USA
| | - Reza Askari
- Division of Trauma/Burns and Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, MA 02115, USA.
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Mutters NT, Mersch-Sundermann V, Mutters R, Brandt C, Schneider-Brachert W, Frank U. Control of the spread of vancomycin-resistant enterococci in hospitals: epidemiology and clinical relevance. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:725-31. [PMID: 24222791 DOI: 10.3238/arztebl.2013.0725] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 06/06/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The spread of vancomycin-resistant enterococci (VRE), particularly E. faecium, in hospitals leads to many cases of colonization, but only sporadic infections. Detailed and valid risk assessment is needed so that patients at risk can be protected from VRE infection. The principal aims of risk assessment must include not only lowering VRE-associated morbidity and mortality in patients at risk, but also refraining from unnecessary anti-infective measures among those who are not at risk. METHODS We selectively searched the PubMed database for pertinent articles on the epidemiology and clinical relevance of VRE in order to derive a uniform and practical hygiene strategy from the available scientific evidence. RESULTS Only low-level evidence is available for the interventions studied to date, and most of the recommendations that have been issued can be characterized as expert opinion. As a rule, VRE are not highly pathogenic; they tend to have high rates of colonization, but low rates of infection. The risk factors for colonization with VRE include (among others) the administration of antibiotics and immunosuppressants, prior hospitalization, diarrhea, intubation, and other invasive treatments. The areas of highest risk are hematology/oncology wards, liver transplantation wards, dialysis units, and neonatology wards. CONCLUSION The chain of infection can be broken by improved and consistently applied standard hygienic measures (hand and surface disinfection). Some patients are nonetheless at elevated risk of VRE infection. In specific clinical situations, the optimal protection of these patients against VRE infection demands the obligatory enforcement of stricter hygienic measures (contact isolation).
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Affiliation(s)
- Nico T Mutters
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene
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Bodily M, McMullen KM, Russo AJ, Kittur ND, Hoppe-Bauer J, Warren DK. Discontinuation of reflex testing of stool samples for vancomycin-resistant enterococci resulted in increased prevalence. Infect Control Hosp Epidemiol 2013; 34:838-40. [PMID: 23838226 PMCID: PMC4689131 DOI: 10.1086/671276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Discontinuation of reflex testing of stool submitted for Clostridium difficile testing for vancomycin-resistant enterococci (VRE) led to an increase in the number of patients with healthcare-associated VRE bacteremia and bacteriuria (0.21 vs 0.36 cases per 1,000 patient-days; P<.01). Cost-benefit analysis showed reflex screening and isolation of VRE reduced hospital costs.
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Affiliation(s)
- Mandy Bodily
- Barnes-Jewish Hospital, Infection Prevention Department, Saint Louis, Missouri, USA.
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Rossini FAF, Fagnani R, Leichsenring ML, Dantas SRPE, Cardoso LGDO, Levy CE, Moretti ML, Trabasso P. Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital. Rev Soc Bras Med Trop 2012; 45:184-8. [PMID: 22534989 DOI: 10.1590/s0037-86822012000200009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 09/22/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe the epidemiological 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.
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Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, and other Gram-positives in healthcare. Curr Opin Infect Dis 2012; 25:385-94. [DOI: 10.1097/qco.0b013e3283553441] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Nguyen GC, Leung W, Weizman AV. Increased risk of vancomycin-resistant enterococcus (VRE) infection among patients hospitalized for inflammatory bowel disease in the United States. Inflamm Bowel Dis 2011; 17:1338-42. [PMID: 21560197 DOI: 10.1002/ibd.21519] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 09/09/2010] [Indexed: 12/09/2022]
Abstract
BACKGROUND Vancomycin-resistant Enterococcus (VRE) infection has become an increasingly common hospital-acquired infection in U.S. hospitals. Patients with inflammatory bowel disease (IBD) frequently require hospitalization and therefore may be at increased risk of nosocomial infections. METHODS We used the Nationwide Inpatient Sample (NIS) to identify admissions for IBD (n = 116,842) between 1998 and 2004. We compared the prevalence of VRE in this group to that of non-IBD gastrointestinal (GI) inpatients and general inpatients and assessed for associations between VRE and hospital mortality, length of stay, and total charges. RESULTS The crude VRE prevalence was 2.1/10,000 in hospitalized IBD patients, 1.3/10,000 in non-IBD GI patients, and 0.9/10,000 in general inpatients. After adjustment for confounders, IBD inpatients were at increased risk of VRE compared to the non-IBD GI (adjusted odds ratio [aOR] 1.65; 95% confidence interval [CI]: 1.03-2.64) and general inpatient (aOR 2.37; 95% CI: 1.31-4.27) groups. Among IBD patients, there was a higher prevalence of VRE infection in those who had surgery (4.4/10,000 versus 1.7/10,000; P < 0.04) and total parenteral nutrition (6.9/10,000 versus 1.8/10,000; P < 0.003). VRE infection was not associated with an increase in mortality (0% versus 0.7%, P = 0.8); however, it was associated with 3-fold higher total hospital charges ($63,517 versus $21,918 USD; P < 0.0001) and increased average length of stay in hospital (16.1 versus 6.1 days; P < 0.0001). CONCLUSIONS Hospitalized IBD patients have increased susceptibility to VRE that is associated with increased economic burden. This study reinforces the importance of measures to prevent nosocomial infection, particularly in the vulnerable IBD population.
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Affiliation(s)
- Geoffrey C Nguyen
- Mount Sinai Hospital IBD Centre, University of Toronto Faculty of Medicine, Toronto, ON, Canada.
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Henard S, Lozniewski A, Aissa N, Jouzeau N, Rabaud C. Evaluation of the duration of vanA vancomycin-resistant Enterococcus faecium carriage and clearance during a large-scale outbreak in a region of eastern France. Am J Infect Control 2011; 39:169-71. [PMID: 20971530 DOI: 10.1016/j.ajic.2010.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 06/30/2010] [Accepted: 07/06/2010] [Indexed: 11/26/2022]
Abstract
A monthly follow-up evaluation of vancomycin-resistant Enterococcus-colonized patients conducted during an outbreak in France revealed that carriage can persist for an extended period. Recurrence was observed despite as many as 3 negative cultures. As a result, we propose another definition for VRE clearance.
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Controlling a vancomycin-resistant enterococci outbreak in a Brazilian teaching hospital. Eur J Clin Microbiol Infect Dis 2010; 30:369-74. [DOI: 10.1007/s10096-010-1095-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022]
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Song JY, Cheong HJ, Jo YM, Choi WS, Noh JY, Heo JY, Kim WJ. Vancomycin-resistant Enterococcus colonization before admission to the intensive care unit: a clinico-epidemiologic analysis. Am J Infect Control 2009; 37:734-40. [PMID: 19188004 DOI: 10.1016/j.ajic.2008.09.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 09/29/2008] [Accepted: 09/30/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Asymptomatic vancomycin-resistant Enterococcus (VRE) colonization is known to precede actual infection. Since VRE was first isolated in Korea in 1992, the VRE isolation rate has rapidly increased in tertiary hospitals. METHODS We performed a prospective observational study to estimate the prevalence of VRE colonization among inpatients at the time of intensive care unit (ICU) admission. From March through December 2007, rectal swab cultures were taken in all patients admitted to the ICU. We aimed to identify the risk factors for VRE colonization on admission. RESULTS During the study period, 34 (4.4%) out of 780 patients were already colonized with VRE before ICU admission: 21 out of 323 patients from general wards (6.5%) and 13 out of 437 patients from outside the hospital (2.97%). VRE-colonized patients were more likely than uncolonized patients to have infectious diseases and to have been referred from outside hospitals (P < .01). Previous hospitalization (P = .01) and antibiotic exposure (P < .01) were risk factors for VRE colonization before ICU admission. Pulsed-field gel electrophoresis patterns were diverse. Initial VRE colonization correlated to poor prognosis. CONCLUSION VRE colonization rate was not negligible among newly admitted ICU patients, suggesting that an active surveillance program focusing on high-risk groups may be helpful.
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Affiliation(s)
- Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Barsanti MC, Woeltje KF. Infection Prevention in the Intensive Care Unit. Infect Dis Clin North Am 2009; 23:703-25. [DOI: 10.1016/j.idc.2009.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Predicting clearance of colonization with vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus by use of weekly surveillance cultures. J Clin Microbiol 2009; 47:1229-30. [PMID: 19244462 DOI: 10.1128/jcm.02424-08] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We analyzed surveillance cultures for vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) collected during a multicenter trial to determine if three negative cultures collected at weekly intervals would predict clearance of VRE or MRSA from colonized patients. Seventy-two percent of VRE-colonized patients and 94% of MRSA-colonized patients were culture negative after three consecutive negative cultures.
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Drees M, Snydman DR, Schmid CH, Barefoot L, Hansjosten K, Vue PM, Cronin M, Nasraway SA, Golan Y. Prior Environmental Contamination Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci. Clin Infect Dis 2008; 46:678-85. [DOI: 10.1086/527394] [Citation(s) in RCA: 211] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Beier RC, Duke SE, Ziprin RL, Harvey RB, Hume ME, Poole TL, Scott HM, Highfield LD, Alali WQ, Andrews K, Anderson RC, Nisbet DJ. Antibiotic and disinfectant susceptibility profiles of vancomycin-resistant Enterococcus faecium (VRE) isolated from community wastewater in Texas. BULLETIN OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2008; 80:188-194. [PMID: 18193143 DOI: 10.1007/s00128-007-9342-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 12/18/2007] [Indexed: 05/25/2023]
Abstract
Vancomycin-resistant Enterococcus faecium (VRE) from human wastewater effluents in a nonclinical semiclosed agri-food system in Texas were characterized for susceptibility to antibiotics and disinfectants. The 50 VRE were resistant to eight fluoroquinolones and 10 of 17 antimicrobials typically active against Gram-positive organisms. The VRE were susceptible to quinupristin/dalfopristin and linezolid. Lack of the insertion element IS1251 correlated with VRE susceptibility to streptomycin and gentamicin at p < 0.0001 and p = 0.033, respectively. An association was observed between pulsed-field gel electrophoresis genotypes Ic and II and susceptibility to streptomycin at p = 0.0006. VRE susceptibility for nine disinfectants and five disinfectant components is shown. Ninety-two percent of the isolates had a minimum inhibitory concentration (MIC) for triclosan > or =2 ppm. Triclosan MICs for many of the VRE were well over expected product application levels. No association was observed between antibiotic resistance and disinfectant susceptibility in these VRE. Enterococci multiply-resistant to vancomycin and aminoglycosides were found in a non-hospital environment where one would not expect to find them.
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Affiliation(s)
- Ross C Beier
- Southern Plains Agricultural Research Center, Agricultural Research Service, US Department of Agriculture, College Station, TX 77845-4988, USA.
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Sakka V, Tsiodras S, Galani L, Antoniadou A, Souli M, Galani I, Pantelaki M, Siafakas N, Zerva L, Giamarellou H. Risk-factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci. Clin Microbiol Infect 2008; 14:14-21. [DOI: 10.1111/j.1469-0691.2007.01840.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Siegel JD, Rhinehart E, Jackson M, Chiarello L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007; 35:S165-93. [PMID: 18068814 DOI: 10.1016/j.ajic.2007.10.006] [Citation(s) in RCA: 681] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jane D Siegel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Lucet JC, Armand-Lefevre L, Laurichesse JJ, Macrez A, Papy E, Ruimy R, Deblangy C, Lozach A, Lolom I, Jarlier V, Andremont A, Leport C. Rapid control of an outbreak of vancomycin-resistant enterococci in a French university hospital. J Hosp Infect 2007; 67:42-8. [PMID: 17719129 DOI: 10.1016/j.jhin.2007.06.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 06/15/2007] [Indexed: 11/25/2022]
Abstract
Vancomycin-resistant enterococci (VRE) are emerging in French hospitals. A VRE outbreak occurred in our hospital, prompting efforts to eradicate the organism. The following interventions were implemented simultaneously to control the outbreak: (1) creation of a VRE control committee; (2) cohorting of VRE carriers in a dedicated ward; (3) extensive screening of contact patients; (4) use of a sensitive technique for detecting VRE in rectal samples; (5) intervention of a dedicated team to reduce consumption of selected antibiotics; (6) information for, and education of, all hospital staff; and (7) electronic tracking of in-hospital transfer and readmission of VRE carriers and contact patients. Over a four-week period following admission of the index case, 37 carriers of a single strain of vanA vancomycin-resistant Enterococcus faecium were identified across seven units. A single additional readmitted contact patient was identified later. Of the 39 VRE-positive patients, two had urinary tract infections and 37 were colonised. Of the 32 patients with known VRE stool concentrations, 23 had low and nine high concentrations. One low-concentration patient precipitated transmission in another unit. This aggressive, co-ordinated, multifaceted strategy was successful in halting a widespread VRE outbreak in our hospital.
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Affiliation(s)
- J-C Lucet
- Infection Control Unit, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
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Weber SG, Huang SS, Oriola S, Huskins WC, Noskin GA, Harriman K, Olmsted RN, Bonten M, Lundstrom T, Climo MW, Roghmann MC, Murphy CL, Karchmer TB. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: Position statement from the Joint SHEA and APIC Task Force. Am J Infect Control 2007; 35:73-85. [PMID: 17327185 DOI: 10.1016/j.ajic.2007.01.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology, Inc., (APIC) have developed this joint position statement. Both organizations are dedicated to combating health care-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, the APIC and the SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) The SHEA and the APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) The APIC and the SHEA welcome efforts by health care consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and health care-associated infections. (4) The SHEA and the APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) The APIC and the SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.
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Affiliation(s)
- Stephen G Weber
- Section of Infectious Diseases, University of Chicago Hospitals, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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Larson EL, Quiros D, Giblin T, Lin S. Relationship of Antimicrobial Control Policies and Hospital and Infection Control Characteristics to Antimicrobial Resistance Rates. Am J Crit Care 2007. [DOI: 10.4037/ajcc2007.16.2.110] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
• Background Antibiotic misuse and noncompliance with infection control precautions have contributed to increasing levels of antimicrobial resistance in hospitals.
• Objectives To assess the extent to which resistance is monitored in infection control programs and to correlate resistance rates with characteristics of antimicrobial control policies, provider attitudes and practices, and systems-level indicators of implementation of the hand hygiene guideline of the Centers for Disease Control and Prevention.
• MethodsAn on-site survey of intensive care unit staff and infection control directors of 33 hospitals in the United States was conducted. The following data were collected: antimicrobial control policies; rates during the previous 12 months of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and ceftazidime-resistant Klebsiella pneumoniae; an implementation score of systems-level efforts to implement the guideline; staff attitudes toward practice guidelines; and observations of staff hand hygiene. Variables associated with resistance rates were examined for independent effects by using logistic regression.
• ResultsResistance rates for S aureus, enterococci, and K pneumoniae were 52.5%, 18.2%, and 16.0%, respectively. Ten (30.3%) hospitals had an antibiotic control policy. No statistically significant correlation was observed between staff attitudes toward practice guidelines, observed hand hygiene behavior, or having an antibiotic use policy and resistance rates. In logistic regression analysis, higher scores on measures of systems-level efforts to implement the guideline were associated with lower rates of resistant S aureus and enterococci (P=.046).
• Conclusions Organizational-level factors independent of the practices of individual clinicians may be associated with rates of antimicrobial resistance.
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Affiliation(s)
- Elaine L. Larson
- School of Nursing (ell, dq, tg, sl) and Mailman School of Public Health (ell), Columbia University, New York, NY
| | - Dave Quiros
- School of Nursing (ell, dq, tg, sl) and Mailman School of Public Health (ell), Columbia University, New York, NY
| | - Tara Giblin
- School of Nursing (ell, dq, tg, sl) and Mailman School of Public Health (ell), Columbia University, New York, NY
| | - Susan Lin
- School of Nursing (ell, dq, tg, sl) and Mailman School of Public Health (ell), Columbia University, New York, NY
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Salgado CD, Ison MG. Should clinicians worry about vancomycin-resistant Enterococcus bloodstream infections? Bone Marrow Transplant 2007; 38:771-4. [PMID: 17133239 DOI: 10.1038/sj.bmt.1705532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Harbarth S, Masuet-Aumatell C, Schrenzel J, Francois P, Akakpo C, Renzi G, Pugin J, Ricou B, Pittet D. Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R25. [PMID: 16469125 PMCID: PMC1550853 DOI: 10.1186/cc3982] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 12/26/2005] [Accepted: 01/03/2006] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Rapid diagnostic tests may allow early identification of previously unknown methicillin-resistant Staphylococcus aureus (MRSA) carriers at intensive care unit (ICU) admission. The aim of this study was twofold: first, to assess whether a new molecular MRSA screening test can substantially decrease the time between ICU admission and identification of MRSA carriers; and, second, to examine the combined effect of rapid testing and pre-emptive contact isolation on MRSA infections. METHOD Since November 2003, patients admitted for longer than 24 hours to two adult ICUs were screened systematically on admission using quick, multiplex immunocapture-coupled PCR (qMRSA). Median time intervals from admission to notification of test results were calculated for a five-month intervention phase (November 2003-March 2004) and compared with a historical control period (April 2003-October 2003) by nonparametric tests. ICU-acquired MRSA infection rates were determined for an extended surveillance period (January 2003 through August 2005) and analyzed by Poisson regression methods. RESULTS During the intervention phase, 97% (450/462) of patients admitted to the surgical ICU and 80% (470/591) of patients admitted to the medical ICU were screened. On-admission screening identified the prevalence of MRSA to be 6.7% (71/1053). Without admission screening, 55 previously unknown MRSA carriers would have been missed in both ICUs. Median time from ICU admission to notification of test results decreased from 87 to 21 hours in the surgical ICU (P < 0.001) and from 106 to 23 hours in the medical ICU (P < 0.001). In the surgical ICU, 1,227 pre-emptive isolation days for 245 MRSA-negative patients were saved by using the qMRSA test. After adjusting for colonization pressure, the systematic on-admission screening and pre-emptive isolation policy was associated with a reduction in medical ICU acquired MRSA infections (relative risk 0.3, 95% confidence interval 0.1-0.7) but had no effect in the surgical ICU (relative risk 1.0, 95% confidence interval 0.6-1.7). CONCLUSION The qMRSA test decreased median time to notification from four days to one day and helped to identify previously unknown MRSA carriers rapidly. A strategy linking the rapid screening test to pre-emptive isolation and cohorting of MRSA patients substantially reduced MRSA cross-infections in the medical but not in the surgical ICU.
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Affiliation(s)
- Stephan Harbarth
- Associate Hospital Epidemiologist, Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jacques Schrenzel
- Director, Clinical Microbiology Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - Patrice Francois
- Senior Research Associate, Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Akakpo
- Infection Control Practitioner, Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| | - Gesuele Renzi
- Laboratory technician, Clinical Microbiology Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - Jerome Pugin
- Attending, Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Bara Ricou
- Attending, Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Didier Pittet
- Director, Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
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Hujer KM, Hujer AM, Hulten EA, Bajaksouzian S, Adams JM, Donskey CJ, Ecker DJ, Massire C, Eshoo MW, Sampath R, Thomson JM, Rather PN, Craft DW, Fishbain JT, Ewell AJ, Jacobs MR, Paterson DL, Bonomo RA. Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center. Antimicrob Agents Chemother 2006; 50:4114-23. [PMID: 17000742 PMCID: PMC1694013 DOI: 10.1128/aac.00778-06] [Citation(s) in RCA: 353] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Military medical facilities treating patients injured in Iraq and Afghanistan have identified a large number of multidrug-resistant (MDR) Acinetobacter baumannii isolates. In order to anticipate the impact of these pathogens on patient care, we analyzed the antibiotic resistance genes responsible for the MDR phenotype in Acinetobacter sp. isolates collected from patients at the Walter Reed Army Medical Center (WRAMC). Susceptibility testing, PCR amplification of the genetic determinants of resistance, and clonality were determined. Seventy-five unique patient isolates were included in this study: 53% were from bloodstream infections, 89% were resistant to at least three classes of antibiotics, and 15% were resistant to all nine antibiotics tested. Thirty-seven percent of the isolates were recovered from patients nosocomially infected or colonized at the WRAMC. Sixteen unique resistance genes or gene families and four mobile genetic elements were detected. In addition, this is the first report of bla(OXA-58)-like and bla(PER)-like genes in the U.S. MDR A. baumannii isolates with at least eight identified resistance determinants were recovered from 49 of the 75 patients. Molecular typing revealed multiple clones, with eight major clonal types being nosocomially acquired and with more than 60% of the isolates being related to three pan-European types. This report gives a "snapshot" of the complex genetic background responsible for antimicrobial resistance in Acinetobacter spp. from the WRAMC. Identifying genes associated with the MDR phenotype and defining patterns of transmission serve as a starting point for devising strategies to limit the clinical impact of these serious infections.
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Affiliation(s)
- Kristine M. Hujer
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Andrea M. Hujer
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Edward A. Hulten
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Saralee Bajaksouzian
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer M. Adams
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Curtis J. Donskey
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - David J. Ecker
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Christian Massire
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Mark W. Eshoo
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Rangarajan Sampath
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Jodi M. Thomson
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Philip N. Rather
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - David W. Craft
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Joel T. Fishbain
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Allesa J. Ewell
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael R. Jacobs
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - David L. Paterson
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A. Bonomo
- Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, Department of Internal Medicine, Department of Pathology, Walter Reed Army Medical Center, Washington, D.C., Department of Pathology, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Ibis, Division of Isis Pharmaceuticals, Carlsbad, California, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia
- Corresponding author. Mailing address: Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Blvd., Cleveland, OH 44106. Phone: (216) 791-3800, ext. 4399. Fax: (216) 229-8509. E-mail:
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Shadel BN, Puzniak LA, Gillespie KN, Lawrence SJ, Kollef M, Mundy LM. Surveillance for vancomycin-resistant enterococci: type, rates, costs, and implications. Infect Control Hosp Epidemiol 2006; 27:1068-75. [PMID: 17006814 DOI: 10.1086/507960] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 12/29/2005] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate 2 active surveillance strategies for detection of enteric vancomycin-resistant enterococci (VRE) in an intensive care unit (ICU). DESIGN Thirty-month prospective observational study. SETTING ICU at a university-affiliated referral center. PATIENTS All patients with an ICU stay of 24 hours or more were eligible for the study. INTERVENTION Clinical active surveillance (CAS), involving culture of a rectal swab specimen for detection of VRE, was performed on admission, weekly while the patient was in the ICU, and at discharge. Laboratory-based active surveillance (LAS), involving culture of a stool specimen for detection of VRE, was performed on stool samples submitted for Clostridium difficile toxin detection. RESULTS Enteric colonization with VRE was detected in 309 (17%) of 1,872 patients. The CAS method initially detected 280 (91%) of the 309 patients colonized with VRE, compared with 25 patients (8%) detected by LAS; colonization in 4 patients (1%) was initially detected by analysis of other clinical specimens. Most patients with colonization (76%) would have gone undetected by LAS alone, whereas use of the CAS method exclusively would have missed only 3 patients (1%) who were colonized. CAS cost Dollars 1,913 per month, or Dollars 57,395 for the 30-month study period. Cost savings of CAS from preventing cases of VRE colonization and bacteremia were estimated to range from Dollars 56,258 to Dollars 303,334 per month. CONCLUSIONS A patient-based CAS strategy for detection of enteric colonization with VRE was superior to LAS. In this high-risk setting, CAS appeared to be the most efficient and cost-effective surveillance method. The modest costs of CAS were offset by the averted costs associated with the prevention of VRE colonization and bacteremia.
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Affiliation(s)
- Brooke N Shadel
- Institute for Bio-Security, School of Public Health, Saint Louis University, Saint Louis, MO 63104, USA.
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Peta M, Carretto E, Barbarini D, Zamperoni A, Carnevale L, Perversi L, Pagani M, Bonora MG, Fontana R, Marone P, Langer M. Outbreak of vancomycin-resistant Enterococcus spp. in an Italian general intensive care unit. Clin Microbiol Infect 2006; 12:163-9. [PMID: 16441455 DOI: 10.1111/j.1469-0691.2005.01331.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Following the identification of two clinical isolates of vancomycin-resistant enterococci (VRE) from intensive care unit (ICU) patients, a surveillance programme detected that six of eight ICU patients were colonised by VRE. Standard epidemic control measures were instituted in the ICU. During a 16-month period, 13 (2.5%) of 509 ICU patients had VRE-positive swabs upon admission, and 43 (8.7%) of 496 VRE-negative patients were colonised by VRE in the ICU. Patients who acquired VRE in the ICU had a longer ICU stay (p < 0.0001). No other statistically significant differences were demonstrated. Two patients had documented infection (infection/colonisation index, 3.6%; overall VRE infection frequency, 0.4%), but both recovered and were discharged. VRE colonisation did not increase the mortality rate. Automated ribotyping identified three clusters containing, respectively, the first 52 Enterococcus faecium isolates, two Enterococcus faecalis isolates, and two further isolates of E. faecium. Multilocus sequence typing demonstrated that two E. faecium isolates representative of the two ribotypes belonged to sequence types 78 and 18, and that these two isolates belonged to the epidemic lineage C1, which includes isolates with a wide circulation in northern Italy. The outbreak was controlled by continuous implementation of the infection control programme, and by the opening of a new unit with an improved structural design and hand-washing facilities.
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Affiliation(s)
- M Peta
- Servizio di Anestesia e Rianimazione II, Area Infettivologica, IRCCS Policlinico San Matteo, Pavia, Italy
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Sherer CR, Sprague BM, Campos JM, Nambiar S, Temple R, Short B, Singh N. Characterizing vancomycin-resistant enterococci in neonatal intensive care. Emerg Infect Dis 2006; 11:1470-2. [PMID: 16229786 PMCID: PMC3310622 DOI: 10.3201/eid1109.050148] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Repetitive sequence-based polymerase chain reaction fingerprinting was used to characterize 23 vancomycin-nonsusceptible enterococcal isolates from 2003 to 2004. Five genetically related clusters spanned geographically distinct referring centers. DNA fingerprinting showed infant-to-infant transmission from referring institutions. Thus, community healthcare facilities are a source of vancomycin-nonsusceptible enterococci and should be targeted for increased infection control efforts.
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Affiliation(s)
| | | | - Joseph M. Campos
- Children's National Medical Center, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - Sumathi Nambiar
- Children's National Medical Center, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - Rachel Temple
- Children's National Medical Center, Washington, DC, USA
| | - Billie Short
- Children's National Medical Center, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - Nalini Singh
- Children's National Medical Center, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
- George Washington University School of Public Health, Washington, DC, USA
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McNeil SA, Malani PN, Chenoweth CE, Fontana RJ, Magee JC, Punch JD, Mackin ML, Kauffman CA. Vancomycin-resistant enterococcal colonization and infection in liver transplant candidates and recipients: a prospective surveillance study. Clin Infect Dis 2005; 42:195-203. [PMID: 16355329 DOI: 10.1086/498903] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 08/30/2005] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vancomycin-resistant enterococcal (VRE) infections cause significant morbidity and mortality among patients undergoing liver transplantation. We performed a prospective study among patients awaiting transplantation to assess rates, risk factors, and outcomes associated with VRE colonization before and after transplantation. METHODS All adults on the transplantation waiting list from 2000-2003 were eligible. Demographic, historical, and laboratory data, as well as stool samples to be analyzed for VRE, were collected at enrollment and every 4-6 months thereafter until transplantation. After transplantation, samples were obtained every 3 days during hospitalization and were analyzed for VRE; outcomes were assessed at 90 days. RESULTS Overall, 375 patients were enrolled in our study, and 142 received transplants. VRE colonization occurred in 50 (13%) of 375 patients before transplantation and was independently associated with treatment with antianaerobic antimicrobials, third-generation cephalosporins, proton pump inhibitors, or neomycin; having a recent endoscopic retrograde cholangiopancreatogram or paracentesis procedure; and admission to the liver unit. Of these 50 patients, 22 (44%) received a transplant, and 7 (32%) of 22 developed a VRE infection after transplantation. An additional 22 patients (18%) who were not colonized before transplantation acquired VRE after transplantation; VRE infection developed in 5 (23%) of these patients. Patients colonized with VRE either before or after transplantation had longer stays in the intensive care unit and the hospital. Mortality at 90 days was significantly greater among those who acquired VRE after transplantation (5 [23%] of 22), compared with those who had VRE colonization before transplantation (2 [9%] of 22). CONCLUSIONS Liver transplantation candidates with VRE colonization before transplantation experience greater morbidity but not greater mortality, compared with noncolonized candidates. Transplant recipients who acquire VRE after transplantation have a higher mortality rate than noncolonized recipients. Strategies should be implemented to reduce nosocomial VRE acquisition after transplantation among this vulnerable group.
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Affiliation(s)
- Shelly A McNeil
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
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Sherer CR, Sprague BM, Campos JM, Nambiar S, Temple R, Short B, Singh N. Characterizing Vancomycin-resistant Enterococci in Neonatal Intensive Care. Emerg Infect Dis 2005. [DOI: 10.3201/eid1209.050148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | - Joseph M. Campos
- Children's National Medical Center, Washington, DC, USA;George Washington University School of Medicine, Washington, DC, USA
| | - Sumathi Nambiar
- Children's National Medical Center, Washington, DC, USA;George Washington University School of Medicine, Washington, DC, USA
| | - Rachel Temple
- Children's National Medical Center, Washington, DC, USA
| | - Billie Short
- Children's National Medical Center, Washington, DC, USA;George Washington University School of Medicine, Washington, DC, USA
| | - Nalini Singh
- Children's National Medical Center, Washington, DC, USA;George Washington University School of Medicine, Washington, DC, USA;George Washington University School of Public Health, Washington, DC, USA
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Faergemann J, Hedner T, Larsson P. The in vitro activity of pentane-1,5-diol against aerobic bacteria. A new antimicrobial agent for topical usage? Acta Derm Venereol 2005; 85:203-5. [PMID: 16040402 DOI: 10.1080/00015550410026128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Multi-resistance to antibiotic therapy and to biocides is becoming increasingly common, which has led to mounting concern worldwide regarding the future use of traditional antimicrobials. Diols or glycols also have antimicrobial effects. Pentane-1,5-diol has low oral toxicity, is essentially non-irritating to the skin and has high antimicrobial activities against bacteria, fungi and viruses. The effect of pentane-1,5-diol against both sensitive and multi-resistant Gram-positive and Gram-negative bacteria was tested in vitro against 85 bacterial strains showing minimal inhibitory concentrations in the range of 2.5 to 15.0% (vol/vol) against both antibiotic-susceptible and multi-resistant aerobic bacteria. The exact mechanism of action is unknown but probably pentane-1,5-diol sucks water out of the bacterial cells which then collapse, a mechanism to which it is probably very difficult to develop resistance. The high activity against multi-resistant bacteria makes pentane-1,5-diol an interesting new compound for topical antimicrobial therapy in humans.
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Affiliation(s)
- Jan Faergemann
- Department of Dermatology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
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Harris AD, Lautenbach E, Perencevich E. A Systematic Review of Quasi-Experimental Study Designs in the Fields of Infection Control and Antibiotic Resistance. Clin Infect Dis 2005; 41:77-82. [PMID: 15937766 DOI: 10.1086/430713] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 03/23/2005] [Indexed: 11/03/2022] Open
Abstract
We performed a systematic review of articles published during a 2-year period in 4 journals in the field of infectious diseases to determine the extent to which the quasi-experimental study design is used to evaluate infection control and antibiotic resistance. We evaluated studies on the basis of the following criteria: type of quasi-experimental study design used, justification of the use of the design, use of correct nomenclature to describe the design, and recognition of potential limitations of the design. A total of 73 articles featured a quasi-experimental study design. Twelve (16%) were associated with a quasi-experimental design involving a control group. Three (4%) provided justification for the use of the quasi-experimental study design. Sixteen (22%) used correct nomenclature to describe the study. Seventeen (23%) mentioned at least 1 of the potential limitations of the use of a quasi-experimental study design. The quasi-experimental study is used frequently in studies of infection control and antibiotic resistance. Efforts to improve the conduct and presentation of quasi-experimental studies are urgently needed to more rigorously evaluate interventions.
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Affiliation(s)
- Anthony D Harris
- Division of Health Care Outcomes Research, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Lee TA, Hacek DM, Stroupe KT, Collins SM, Peterson LR. Three surveillance strategies for vancomycin-resistant enterococci in hospitalized patients: detection of colonization efficiency and a cost-effectiveness model. Infect Control Hosp Epidemiol 2005; 26:39-46. [PMID: 15693407 DOI: 10.1086/502485] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness and detection sensitivity associated with three active surveillance strategies for the identification of patients harboring vancomycin-resistant enterococci (VRE) to determine which is the most medically and economically useful. DESIGN Culture for VRE from 200 consecutive stool specimens submitted for Clostridium difficile culture. Following this, risk factors were assessed for patients whose culture yielded VRE, and a cost-effectiveness evaluation was performed using a decision analytic model with a probabilistic analysis. SETTING A 688-bed, tertiary-care facility in Chicago, Illinois, with approximately 39,000 annual admissions, 7,000 newborn deliveries, 56,000 emergency department visits, and 115,000 home care and 265,000 outpatient visits. SUBJECTS All stool specimens submitted to the clinical microbiology laboratory for C. difficile culture from hospital inpatients. RESULTS From 200 stool samples submitted for C. difficile testing, we identified 5 patients with VRE in non-high-risk areas not screened as part of our routine patient surveillance. Medical record review revealed that all 5 had been hospitalized within the prior 2 years. Three of 5 had a history of renal impairment. The strategy that would involve screening the greatest number of patients (all those with a history of hospital admission in the prior 2 years) resulted in highest screening cost per patient admitted (dollars 2.48), lower per patient admission costs (dollars 480), and the best survival rates. CONCLUSION An expanded VRE surveillance program that encompassed all patients hospitalized within the prior 2 years was a cost-effective screening strategy compared with a more traditional one focused on high-risk units.
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Affiliation(s)
- Todd A Lee
- Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, IL 60141, USA.
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Kaye KS, Harris AD, Samore M, Carmeli Y. The case-case-control study design: addressing the limitations of risk factor studies for antimicrobial resistance. Infect Control Hosp Epidemiol 2005; 26:346-51. [PMID: 15865269 DOI: 10.1086/502550] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE There are significant limitations of the standard case-control study design for identifying risk factors for resistant organisms. The objective of this study was to develop a study design to overcome these limitations. DESIGN Theoretical analysis of different types of study designs that can be used in risk factor studies for resistant organisms. RESULTS We developed the case-case-control study design, which uses two separate case-control analyses within a single study. The first analysis compares patients infected with resistant bacteria (resistant cases) with control-patients without infection caused by the target organism, who are therefore representative of the source population; and the second analysis compares patients infected with the susceptible phenotype of the target organism (susceptible cases) with the same control-patients without infection caused by the target organism. These two analyses provide risk models for (1) isolation of the resistant phenotype of the target organism as compared with the source population and (2) isolation of the susceptible phenotype of the organism as compared with the source population. When these two risk models are compared and contrasted, risk factors specifically associated with isolation of the resistant phenotype can be identified. CONCLUSIONS The case-case-control study design is an effective method for identifying risk factors for antimicrobial-resistant pathogens. Although the case-case-control study design has limitations, it is, in our opinion, more informative and less flawed than the standard case-control study design.
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Affiliation(s)
- Keith S Kaye
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
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Disinfection Policies in Hospitals and the Community. ANTIBIOTIC POLICIES 2005. [PMCID: PMC7122093 DOI: 10.1007/0-387-22852-7_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Diekema DJ, Dodgson KJ, Sigurdardottir B, Pfaller MA. Rapid detection of antimicrobial-resistant organism carriage: an unmet clinical need. J Clin Microbiol 2004; 42:2879-83. [PMID: 15243032 PMCID: PMC446269 DOI: 10.1128/jcm.42.7.2879-2883.2004] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daniel J Diekema
- Department of Internal Medicine, Division of Medical Microbiology, C 606 GH, 200 Hawkins Dr., Iowa City, IA 52242, USA.
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