Low prevalence of vancomycin resistant enterococci colonization in intensive care patients in a Brazilian teaching hospital

Tresoldi, Antônia Teresinha; Cardoso, L. P.; Castilho, Giane V.; Dantas, Sônia Regina Pérez Evangelista; Nowakonski, Angela von; Pereira, Ricardo; Trabasso, Plı́nio

doi:10.1590/s1413-86702006000400004

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…Demographics characteristics, APACHE II score, and mortality were similar during the pre-and postintervention periods, showing that the population was homogenous during the study period. In contrast with other reports in Brazil, E. faecium was the most frequent specie of VRE identified in our hospital and the vanA gene was identified in all strains causing infection [16][17][18].…”

Section: Discussioncontrasting

confidence: 98%

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Impact of the reduction of environmental and equipment contamination on vancomycin-resistant enterococcus rates

et al. 2011

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More than 1,500 perirectal swab cultures and 552 environmental and equipment cultures were collected during the study period. Enterococcus faecium was the most frequent species isolated, being responsible for 71% of the positive cultures. Fifty infections were documented, with bloodstream infections (18, 36%) being the most frequent, followed by urinary tract infection (15, 30%). An educational intervention was given to 136 healthcare workers (HCWs), and a questionnaire regarding vancomycin-resistant enterococcus (VRE) transmission was also performed pre- and post-intervention. Overall, 858 opportunities of patient care were evaluated. The compliance with contact precautions did not improve; however, in general, the proportion of correct answers regarding VRE increased significantly when comparing pre- and post-intervention periods (p < 0.05). On the other hand, the proportion of environmental and equipment contaminated by VRE decreased significantly from pre- (23.2%) to post-intervention (8.2%) (p < 0.001) and was associated with a significant decrease in VRE infection from 7.7 to 1.9 when comparing the pre- and post-intervention periods. The use of vancomycin (defined daily dose [DDD]) did not change significantly over the study period (p = 0.970), and the use of teicoplanin increased (p < 0.001). Seventy-six percent of E. faecium belong to type and subtype A by pulsed-field gel electrophoresis (PFGE). This predominant type was found in the environment and caused colonization and infection. In conclusion, the present study showed that reduction of the proportion of environmental and equipment contamination was associated with a decrease of colonization and infection due to VRE, and that the strategy to control VRE dissemination should be based on local problems.

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Section: Discussioncontrasting

confidence: 98%

“…VRE was first described in Brazil in 1996 [16]. Variation in the prevalence of colonization among Brazilian hospitals is high, with reported rates from 0 to 33% [16][17][18]. In the present study, the rate of colonization ranged in the baseline period from 1.99 to 36.29 colonized patients per 1,000 patient-days.…”

Section: Discussionmentioning

confidence: 55%

Impact of the reduction of environmental and equipment contamination on vancomycin-resistant enterococcus rates

et al. 2011

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“…In High-level gentamicin-resistant E. faecalis bacteremia www.bjournal.com.br addition, our results emphasize the need for strategies to improve infection-control practices, such as judicious use of antibiotics and monitoring of antibiotic resistance among hematologic patients. This could prevent further dissemination of HLGR, allow the monitoring of changes in enterococcal resistance patterns, and ultimately prevent the spread of VRE at our institution, which is currently limited to a few cases of colonization (20).…”

Section: Discussionmentioning

confidence: 99%

Clinical, epidemiological, and microbiological characteristics of bacteremia caused by high-level gentamicin-resistant Enterococcus faecalis

Vigani

Oliveira

Bratfich

et al. 2008

Braz J Med Biol Res

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Enterococcus spp bacteremia is associated with high mortality and the appearance of high-level gentamicin resistance (HLGR) created additional challenges for the treatment of these infections. We evaluated the epidemiological and clinical characteristics of patients with bacteremias caused by HLGR and non-HLGR Enterococcus faecalis isolates at a teaching hospital in the State of São Paulo, Brazil. Patients with bacteremia due to E. faecalis diagnosed between January 1999 and December 2003 were included in the study. We collected clinical, epidemiological, and microbiological data from medical records. Banked isolates were typed using pulsed-field gel electrophoresis. We identified 145 cases of E. faecalis bacteremia: 66 (45.5%) were caused by HLGR isolates and 79 (54.5%) by non-HLGR. In the univariate analysis, patients with HLGR infection were older, had higher rates of bladder catheterization, and more often had treatment with cephalosporin, quinolone, and/or carbapenem compared with patients with non-HLGR infection (P < 0.05). Multivariate analysis indicated that older age, hematological malignancy, and previous use of vancomycin were independently associated with HLGR (P < 0.05). Mortality rates were not significantly different among patients with HLGR (50%) and non-HLGR (43%) infections (P = 0.40). Of the 32 genotyped isolates, 16 were distributed into 6 main electrophoresis patterns and 16 others had distinct patterns. E. faecalis bacteremia is associated with high mortality and is frequently caused by HLGR isolates at this teaching hospital. The variability among genotyped isolates suggests that endogenous infections, rather than patient-to-patient transmission of E. faecalis, are more common at this institution.

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“…These rates are among the highest reported in Europe. Fecal colonization of VRE was found that 1.4% of hospitalized patients in The Netherlands 17 , 3.5% in Belgium 18 , 8% in Brazil 19 . The authors hypothesized that this was related to the limited use of glycopeptide antibiotics, the absence of cross-contamination, structured surveillance program.…”

Section: Discussionmentioning

confidence: 99%

Prevalência e fatores de risco associados à colonização por enterococos resistente à vancomicina

Yılmaz¹,

Ağuş²,

Yurtsever³

et al. 2009

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Os enterococos foram reconhecidos como patógenos clinicamente importantes na população de alto risco de pacientes hospitalizados. Os objetivos deste estudo foram detectar a prevalência da colonização por enterocos intestinais resistentes à vancomicina (VRE) no Hospital Tepecik, Izmir, Turquia, entre pacientes dos serviços de alto risco e os fatores de risco relacionados com a resistência em pacientes internados onde a VRE foi raramente isolada anteriormente. Após o primeiro isolamento de VRE em dois pacientes na unidade de terapia intensiva (UTI) e UTI neonatal, no mesmo dia, foi realizado um levantamento de prevalência utilizando swab retal. Para efeito de comparação, 30 amostras de pacientes-controle do serviço de controle de medicina interna também foram analisadas. Noventa e três pacientes foram investigados. Dezoito pacientes (19,3%) foram considerados portadores de VRE, apesar de nenhum dos pacientes do grupo controle tinham VRE. Treze cepas foram identificadas como Enterococcus faecium, quatro foram Enterococcus gallinorum, e um foi Enterococcus casseliflavus. Nove cepas de E. faecium foram resistentes à vancomicina, os restos eram de resistência intermediária à vancomicina e todos eles sensíveis à teicoplanina. O tempo de permanência hospitalar, idade e peso baixo ao nascer de recém-nascidos foram significativamente associados à colonização por VRE. A alta prevalência de colonização por VRE foi encontrado em nossas UTIs, enfatizando a importância do tempo de internação na UTI e baixo peso ao nascer de recém-nascidos como fator de risco para a colonização. A colonização por VRE deve ser monitorada e fatores de risco devem ser determinados, no intuito de estabelecer medidas de prevenção e controle.

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Low prevalence of vancomycin resistant enterococci colonization in intensive care patients in a Brazilian teaching hospital

Cited by 7 publications

References 26 publications

Impact of the reduction of environmental and equipment contamination on vancomycin-resistant enterococcus rates

Impact of the reduction of environmental and equipment contamination on vancomycin-resistant enterococcus rates

Clinical, epidemiological, and microbiological characteristics of bacteremia caused by high-level gentamicin-resistant Enterococcus faecalis

Prevalência e fatores de risco associados à colonização por enterococos resistente à vancomicina

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