1
|
Epidemiology of vancomycin-resistant enterococci in Canadian hospitals (CANWARD study, 2007 to 2013). Antimicrob Agents Chemother 2015; 59:4315-7. [PMID: 25896693 DOI: 10.1128/aac.00384-15] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/12/2015] [Indexed: 11/20/2022] Open
Abstract
Of 1,927 Enterococcus species isolates collected across Canada from 2007 to 2013, 80 (4.2%) were identified as vancomycin-resistant enterococci (VRE). VRE infections during this time tripled in Canadian hospitals, from 1.8% to 6.0% (P = 0.03). All VRE were Enterococcus faecium, with 90% possessing vanA. The prevalence of vanB decreased from 37.5% in 2007 to 0% in 2013 (P < 0.05). The VRE were multidrug resistant, but 70.6%, 86.3%, and 100% were susceptible to doxycycline, linezolid, and daptomycin, respectively.
Collapse
|
2
|
McCracken M, Wong A, Mitchell R, Gravel D, Conly J, Embil J, Johnston L, Matlow A, Ormiston D, Simor AE, Smith S, Du T, Hizon R, Mulvey MR. Molecular epidemiology of vancomycin-resistant enterococcal bacteraemia: results from the Canadian Nosocomial Infection Surveillance Program, 1999-2009. J Antimicrob Chemother 2013; 68:1505-9. [DOI: 10.1093/jac/dkt054] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
3
|
Antibiotic resistance in Canada at the dawn of the new millennium - a model for the developed world? Can J Infect Dis 2011; 11:232-5. [PMID: 18159295 DOI: 10.1155/2000/949584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
4
|
The emerging epidemiology of VRE in Canada: results of the CNISP Passive Reporting Network, 1994 to 1998. Can J Infect Dis 2011; 12:364-70. [PMID: 18159364 DOI: 10.1155/2001/424608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2001] [Accepted: 06/12/2001] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To provide a rapid and efficient means of collecting descriptive epidemiological data on occurrences of vancomycin-resistant enterococcus (VRE) in Canada. DESIGN AND METHODS Passive reporting of data on individual or cluster occurrences of VRE using a one-page surveillance form. SETTING The surveillance form was periodically distributed to all Canadian Hospital Epidemiology Committee members, Community and Hospital Infection Control Association members, L'Association des professionnels pour la prevention des infections members and provincial laboratories, representing 650 health care facilities across Canada. PATIENTS Patients colonized or infected with VRE within Canadian health care facilities. RESULTS Until the end of 1998, 263 reports of VRE were received from 113 health care facilities in 10 provinces, comprising a total of 1315 cases of VRE, with 1246 cases colonized (94.7%), 61 infected (4.6%)and eight of unknown status. (0.6%). VRE occurrences were reported in 56% of acute care teaching facilities and 38% of acute care community facilities. All facilities of more than 800 beds reported VRE occurences compared with only 10% of facilities with less than 200 beds (r2=0.86). Medical and surgical wards accounted for 51.4% of the reported VRE occurences. Sixty-five (24.7%) reports indicated an index case was from a foreign country, with 85.2% from the United States and 14.8% from other countries. Some type of screening was conducted in 50% of the sites. CONCLUSIONS A VRE passive reporting network provided a rapid and efficient means of providing data on the evolving epidemiology of VRE in Canada.
Collapse
|
5
|
|
6
|
Low prevalence of VRE gastrointestinal colonization of hospitalized patients in Manitoba tertiary care and community hospitals. Can J Infect Dis 2010; 11:38-41. [PMID: 18159264 DOI: 10.1155/2000/356317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/1999] [Accepted: 03/29/1999] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the prevalence of vancomycin-resistant enterococci (VRE) bowel colonization in hospitalized patients in Manitoba who had stool specimens collected for Clostridium difficile toxin and/or culture testing. DESIGN Two tertiary care and five community hospitals in Winnipeg and three rural Manitoba community hospitals participated in this study. From January 1 to December 31, 1997 stool specimens, one per patient, submitted to hospital microbiology laboratories for C difficile toxin and/or culture testing were screened for VRE on colistin-nalidixic acid-vancomycin (6 microg/mL) (CNAV) agar plates. The study was divided into six, eight-week intervals. Stool specimens received in the first two weeks of each eight week interval were screened for VRE. MAIN RESULTS A total of 1408 stool specimens were submitted over the 48-week study period. Sixty-seven (4.8%) patients with VRE colonization of their lower gastrointestinal tract were identified. Three of the 67 (4.5%) VRE isolates were Enterococcus faecium, with the remaining 64 (95.5%) were Enterococcus gallinarum. The three vancomycin-resistant E faecium -VREF- (from two different Winnipeg hospitals) demonstrated the vanA genotype, and were resistant to vancomycin, teicoplanin and ampicillin. All three VREF isolates also demonstrated high level resistance to both gentamicin and streptomycin but were susceptible to quinuprisitin/dalfopristin and LY333328. CONCLUSION VRE colonization in hospitalized patients in Manitoba is infrequent and most commonly due to E gallinarum. The prevalence of VREF colonization in the patients studied was 0.2% (three of 1408).
Collapse
|
7
|
Nolan SM, Gerber JS, Zaoutis T, Prasad P, Rettig S, Gross K, McGowan KL, Reilly AF, Coffin SE. Outbreak of vancomycin-resistant enterococcus colonization among pediatric oncology patients. Infect Control Hosp Epidemiol 2009; 30:338-45. [PMID: 19239375 DOI: 10.1086/596202] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To detect the burden of vancomycin-resistant Enterococcus (VRE) colonization among pediatric oncology patients and to determine risk factors for VRE acquisition. DESIGN Retrospective case-control study. SETTING The Children's Hospital of Philadelphia. PATIENTS Pediatric oncology patients hospitalized from June 2006 through December 2007. METHODS Prevalence surveys revealed an increased VRE burden among pediatric oncology patients. For the case-control study, the 16 case patients were pediatric oncology patients who had 1 stool sample negative for VRE at screening before having a stool sample positive for VRE at screening; the 62 control patients had 2 consecutive screenings in which stool samples were negative for VRE. Case and control patients were matched on the duration of the interval between screens. Analyses were performed to determine the association between multiple exposures and VRE acquisition. RESULTS The prevalence survey revealed that 5 (9.6%) of 52 patients had unsuspected VRE colonization at the time of hospitalization. Multivariate analysis identified a lack of empirical contact precautions (odds ratio [OR], 17.16 [95% confidence interval {CI}, 1.49-198.21]; P= .02) and the presence of a gastrointestinal device (OR, 4.03 [95% CI, 1.04-15.56]; P= .04) as significant risk factors for acquisition of VRE. Observations in the interventional radiology department revealed that staff could not access the portions of the electronic medical record in which isolation precautions were documented. Simple interventions that granted access and that trained interventional radiology staff to review the need for precautions, coupled with enhanced infection control practices, interrupted ongoing transmission and reduced the proportion of VRE screens that were positive to 15 (1.2%) of 1,270. CONCLUSIONS Inadequate communication with regard to infection control precautions can increase the risk of transmission of epidemiologically important organisms, particularly when patients receive care at multiple clinic locations. Adherence to infection control practices across the spectrum of care may limit the spread of resistant organisms.
Collapse
Affiliation(s)
- Sheila M Nolan
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Ofner-Agostini M, Johnston BL, Simor AE, Embil J, Matlow A, Mulvey M, Ormiston D, Conly J. Vancomycin-resistant enterococci in Canada: results from the Canadian nosocomial infection surveillance program, 1999-2005. Infect Control Hosp Epidemiol 2008; 29:271-4. [PMID: 18241031 DOI: 10.1086/528812] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Surveillance for vancomycin-resistant enterococci (VRE) in sentinel Canadian hospitals has been conducted since 1999. From 1999 to 2005, the rate of VRE detection increased from 0.37 to 1.32 cases per 1,000 patients admitted, and the rate of VRE infection increased from 0.02 to 0.05 cases per 1,000 patients admitted. Thirty-three percent of all patients with VRE detected that were reported during 1999-2005 were identified in 2005, with increases seen in all regions of Canada. Although the incidence rate of VRE carriage in Canada is increasing, it remains very low.
Collapse
Affiliation(s)
- Marianna Ofner-Agostini
- Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Sunnybrook Health Sciences Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Antimicrobial resistance: A continuing Canadian tale. Can J Infect Dis 2007; 13:350-2. [PMID: 18159410 DOI: 10.1155/2002/574362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
10
|
Conly J. Antimicrobial resistance in Canada. CMAJ 2002; 167:885-91. [PMID: 12406948 PMCID: PMC128402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Antibiotic resistance has increased rapidly during the last decade, creating a serious threat to the treatment of infectious diseases. Canada is no exception to this worldwide phenomenon. Data from the Canadian Nosocomial Infection Surveillance Program have revealed that the incidence of methicillin-resistant Staphylococcus aureus, as a proportion of S. aureus isolates, increased from 1% in 1995 to 8% by the end of 2000, and vancomycin-resistant enterococcus has been documented in all 10 provinces since the first reported outbreak in 1995. The prevalence of nonsusceptible Streptococcus pneumoniae in Canada in 2000 was found to be 12%. Human antimicrobial prescriptions, adjusted for differences in the population, declined 11% based on the total number of prescriptions dispensed between 1995 and 2000. There was also a 21% decrease in beta-lactam prescriptions during this same period. These data suggest that systematic efforts to reduce unnecessary prescribing of antimicrobials to outpatients in Canada, beginning after a national consensus conference in 1997, may be having an impact. There is, however, still a need for continued concerted efforts on a national, provincial and regional level to quell the rising tide of antibiotic resistance.
Collapse
Affiliation(s)
- John Conly
- Centre for Antimicrobial Resistance, University of Calgary, Alta.
| |
Collapse
|
11
|
Sundsfjord A, Simonsen GS, Courvalin P. Human infections caused by glycopeptide-resistant Enterococcus spp: are they a zoonosis? Clin Microbiol Infect 2002; 7 Suppl 4:16-33. [PMID: 11688531 DOI: 10.1046/j.1469-0691.2001.00055.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following the detection of glycopeptide-resistant enterococci (GRE) in 1986 and their subsequent global dissemination during the 1990s, many studies have attempted to identify the reservoirs and lines of resistance transmission as a basis for intervention. The eradication of reservoirs and the prevention of GRE spread is of major importance for two reasons: (i) the emergence of high-level glycopeptide resistance in invasive enterococcal clinical isolates that are already multiresistant, has left clinicians with therapeutic options that are only at the experimental stage; and (ii) the resistance genes may spread to more virulent bacterial species such as Staphylococcus aureus, Streptococcus pneumoniae and Clostridium difficile. VanA-type strains, resistant to high levels of both vancomycin and teicoplanin, are the most commonly encountered enterococci with acquired glycopeptide resistance in humans. A widespread VanA-type GRE reservoir was detected early in farm animals that were exposed to the glycopeptide growth-promoter avoparcin. Numerous studies have provided indirect evidence for the transfer of VanA-type GRE and their resistance determinants from animal reservoirs to humans. The data collected have expanded our understanding of the promiscuous nature of antibiotic resistance, and have provided the groundwork for logical decision-making with the objective of deterring the dissemination of resistant bacteria and of their resistance genes.
Collapse
Affiliation(s)
- A Sundsfjord
- Unité des Agents Antibactériens, Institut Pasteur, Paris, France.
| | | | | |
Collapse
|
12
|
Abstract
Glycopeptide resistance may be either constitutive or transferable (on plasmids or as a transposon), and four phenotypes (van A, B, C, D) have been described to date. Recent data suggest solid media screening protocols appear to be insensitive at detecting low levels of carriage, and up to 40% of colonized patients may be falsely glycopeptide-resistant enterococci (GRE) negative. Managing GRE-colonized or -infected patients using contact precautions appears to be useful in controlling clonal outbreaks, but may be of limited utility once GRE is endemic. Alternate strategies to manage GRE-colonized patients with prolonged carriage and in outpatient or home health settings include using risk-based transmission assessment to limit the logistic and psychosocial difficulties associated with the use of continuous contact precautions. The therapeutic options for treating GRE infection remain limited. Attempts to decolonize GRE-colonized patients with bacitracin appear to be of limited utility.
Collapse
|
13
|
Karlowsky JA, Zhanel GG, Hoban DJ. Vancomycin-resistant enterococci (VRE) colonization of high-risk patients in tertiary care Canadian hospitals. Canadian VRE Surveillance Group. Diagn Microbiol Infect Dis 1999; 35:1-7. [PMID: 10529874 DOI: 10.1016/s0732-8893(99)00045-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We isolated 1487 Enterococcus species from 1200 stool specimens collected from high-risk patients in 12 Canadian tertiary care hospitals between October 1995 and November 1996. The composition of the 1487 isolates was 601 vancomycin-sensitive Enterococcus faecalis (40.4%), 667 vancomycin-sensitive Enterococcus faecium (44.9%), 18 vancomycin-resistant (nine isolates MIC 8-16 micrograms/mL; nine isolates MIC > or = 32 micrograms/mL) E. faecium (VREF) (1.2%), 95 vancomycin-sensitive Enterococcus gallinarum (6.4%), 29 vancomycin-resistant (all MICs 8-16 micrograms/mL) E. gallinarum (2.0%), and 77 vancomycin-sensitive Enterococcus casseliflavus (5.2%). Nine of the 18 VREF isolates collected possessed the vanA genotype and were from three patients at one hospital. Two other VREF isolates, of the vanB genotype, were from a single patient at a second hospital, and the remaining seven isolates, also all of the vanB genotype, were from five patients at a third hospital. All VREF were ampicillin resistant (MIC > or = 16 micrograms/mL), streptomycin resistant (MIC > 1000 micrograms/mL), and ciprofloxacin resistant (MIC > or = 4 micrograms/mL). Ten of the 18 VREF were also resistant to gentamicin (MIC > 500 micrograms/mL), while all 18 isolates had quinupristin/dalfopristin MICs < or = 0.5 microgram/mL. In conclusion, high-risk patients in tertiary care Canadian hospitals are rarely colonized (9/1200 patients, 0.75%) with VREF in their lower gastrointestinal tract. These findings correlate well with the lack of reported VREF infection in high-risk patients in Canadian hospitals. Quinupristin/dalfopristin demonstrated excellent in vitro activity against VREF and other non-faecalis species of Enterococcus, many of which also possessed high-level ampicillin, and/or high-level aminoglycoside, and/or ciprofloxacin resistance.
Collapse
Affiliation(s)
- J A Karlowsky
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | | | | |
Collapse
|
14
|
Greenaway CA, Miller MA. Lack of transmission of vancomycin-resistant enterococci in three long-term-care facilities. Infect Control Hosp Epidemiol 1999; 20:341-3. [PMID: 10349951 DOI: 10.1086/501628] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Three patients colonized with vancomycin-resistant Enterococcus were admitted to one or more of three long-term-care facilities. Six point-prevalence surveys revealed no transmission of vancomycin-resistant Enterococcus after a total of 234 days of exposure during which moderately strict infection control measures were implemented. Four of 116 environmental cultures were positive.
Collapse
Affiliation(s)
- C A Greenaway
- Department of Microbiology at the Centre Hospitalier Régionale du Suroît, Valleyfield-de-Salaberry, Canada
| | | |
Collapse
|
15
|
Turenne CY, Hoban DJ, Karlowsky JA, Zhanel GG, Kabani AM. Screening of stool samples for identification of vancomycin-resistant Enterococcus isolates should include the methyl-alpha-D-glucopyranoside test to differentiate nonmotile Enterococcus gallinarum from E. faecium. J Clin Microbiol 1998; 36:2333-5. [PMID: 9666016 PMCID: PMC105042 DOI: 10.1128/jcm.36.8.2333-2335.1998] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The methyl-alpha-D-glucopyranoside (MDG) test has been shown to be superior to motility testing in differentiating Enterococcus faecium from E. gallinarum. In the present study, 33 vancomycin-resistant enterococcus (VRE) isolates collected as part of a stool surveillance study were compared by using motility and MDG. Motility testing identified all 33 isolates as E. faecium, whereas MDG identified 11 of the 33 isolates as nonmotile E. gallinarum. The MDG results were confirmed by sequencing the 16S rDNA V6-to-V8 region. We conclude that the MDG test is a necessary component of routine VRE screening.
Collapse
Affiliation(s)
- C Y Turenne
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
| | | | | | | | | |
Collapse
|
16
|
Zhanel GG, Karlowsky JA, Hoban DJ. In vitro activities of six fluoroquinolones against Canadian isolates of vancomycin-sensitive and vancomycin-resistant Enterococcus species. Diagn Microbiol Infect Dis 1998; 31:343-7. [PMID: 9635908 DOI: 10.1016/s0732-8893(98)00019-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The in vitro activities of six fluoroquinolones were determined against 1482 Enterococcus species isolates collected as part of a 1996 Canadian surveillance study. Clinafloxacin MIC90s were 4 or 8 microg/mL, trovafloxacin and BAY 12-8039 MIC90s were 8 or 16 microg/mL, sparfloxacin MIC90s were 32 microg/mL, and ciprofloxacin and ofloxacin MIC90s were >32 microg/mL for the vancomycin-sensitive Enterococcus faecalis, vancomycin-sensitive Enterococcus faecium, and vancomycin-resistant E. faecium isolates collected.
Collapse
Affiliation(s)
- G G Zhanel
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | | | | |
Collapse
|