Enterococci Resistant to Multiple Antimicrobial Agents, Including Vancomycin: Establishment of Endemicity in a University Medical Center

Jg, Morris; Shay, David K.; Jn, Hebden; McCarter, Robert; Be, Perdue; Jarvis, William R.; Ja, Johnson; Tc, Dowling; Lb, Polish; Rs, Schwalbe

doi:10.7326/0003-4819-123-4-199508150-00002

Cited by 459 publications

(323 citation statements)

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“…Published reports support the hypothesis that after VCE are introduced, the rates of colonization and infection increase and vancomycin-resistant enterococci become endemic unless effective control measures are introduced [20,21]. Ostrowski et al [22] in an endemic period on the presence of VRE in a surgical ICU, found 12% colonization and the following risk factors: use of second and third generation cephalosporin, length of hospital stay, plus ICU hospitalization and solid-organ transplants.…”

Section: Discussionmentioning

confidence: 94%

Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil

Furtado¹,

Martins²,

Coutinho³

et al. 2005

Braz J Infect Dis

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Vancomycin-resistant enterococci (VRE) are important pathogens causing nosocomial infections, and there is reason for concern about their resistance and great ability to spread in hospital environments, especially intensive-care units (ICU). To determine the prevalence of rectal colonization by VRE, and the risk factors associated with their presence, rectal surveillance swabs were taken from patients under treatment in two intensive-care units (one medical and another both medical and surgical) at São Paulo Hospital, over a two-year period. Thirty-three percent of the 147 patients evaluated had VRE. The only significant variable in the logistic regression was the length of stay in the ICU.

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Section: Discussionmentioning

confidence: 94%

Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil

Furtado¹,

Martins²,

Coutinho³

et al. 2005

Braz J Infect Dis

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“…Typically R p ) 1 and R h ( 1, only the product R 0 R p R h must be greater than unity for transmission. Therefore in endemic settings the model predicts that y Ã p ) y Ã h , providing one explanation of the observational ¢nding that culturing the hands of HCWs seldom provides pathogen isolates (Morris et al 1995).…”

Section: Transmission Dynamics Of Antibiotic Resistant Pathogens In Hmentioning

confidence: 99%

Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models

Austin

Anderson

1999

Phil. Trans. R. Soc. Lond. B

172

127

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The emergence of antibiotic resistance in a wide variety of important pathogens of humans presents a worldwide threat to public health. This paper describes recent work on the use of mathematical models of the emergence and spread of resistance bacteria, on scales ranging from within the patient, in hospitals and within communities of people. Model development starts within the treated patient, and pharmacokinetic and pharmacodynamic principles are melded within a framework that mirrors the interaction between bacterial population growth, drug treatment and the immunological responses targeted at the pathogen. The model helps identify areas in which more precise information is needed, particularly in the context of how drugs in£uence pathogen birth and death rates (pharmacodynamics). The next area addressed is the spread of multiply drug-resistant bacteria in hospital settings. Models of the transmission dynamics of the pathogen provide a framework for assessing the relative merits of di¡erent forms of intervention, and provide criteria for control or eradication. The model is applied to the spread of vancomycin-resistant enterococci in an intensive care setting. This model framework is generalized to consider the spread of resistant organisms between hospitals. The model framework allows for heterogeneity in hospital size and highlights the importance of large hospitals in the maintenance of resistant organisms within a de¢ned country. The spread of methicillin resistant Staphylococcus aureus (MRSA) in England and Wales provides a template for model construction and analysis. The ¢nal section addresses the emergence and spread of resistant organisms in communities of people and the dependence on the intensity of selection as measured by the volume or rate of drug use. Model output is ¢tted to data for Finland and Iceland and conclusions drawn concerning the key factors determining the rate of spread and decay once drug pressure is relaxed.

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“…15,16 At present, VRE is a common intestinal colonizer among hospitalized individuals. 5 Vancomycin-resistant E. faecium has been isolated increasingly among patients in intensive care units. 11,12 Furthermore, VRE faecium has also been associated with an increased incidence of bacteremia 17,18 and mortality.…”

Section: Tablementioning

confidence: 99%

“…19 Enterococci readily acquire antibiotic resistant genes and elaborate substances which promote adherence to host tissues, induce tissue damage, and produce inflammatory reactions. 10 Risk factors predicting the acquisition of VRE include the presence of a central venous catheter, neutropenia, 20 intestinal colonization, 5,17 recent or current administration of vancomycin, third generation cephalosporins, metronidazole, clindamycin or imipenem, 5,17,21 severity of underlying disease, 5 7 or more days of hospitalization especially in a surgical ICU, 21 more than 7 days of vancomycin use, 21 and transfer between floors. 21 Most of the patients in the current study were neutropenic and all were severely immuno-compromised.…”

Section: Tablementioning

confidence: 99%

“…Enterococci are important pathogens and have emerged as the second most common cause of nosocomial infections in the USA. [4][5][6] The emergence of strains of enterococci which are resistant to conventional antibiotic therapy is of particular concern. Infection with vancomycin-resistant enterococcus (VRE) species in severely immuno-compromised individuals, such as those who have recently undergone HDC followed by allogeneic or autologous transplantation, has the potential for significant morbidity and mortality.…”

mentioning

confidence: 99%

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Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation

Kapur

Dorsky

Feingold

et al. 2000

Bone Marrow Transplant

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Summary:A retrospective evaluation of 321 consecutive recipients of high-dose chemotherapy (HDC) and autologous peripheral blood stem cell transplantation (PBSCT) was conducted to ascertain the incidence and outcome of vancomycin-resistant enterococcal (VRE) bacteremia. Ten patients developed VRE bacteremia at a median of 6 days following PBSCT. Nine isolates were Enterococcus faecium and one was E. faecalis. The median duration of bacteremia was 5 days. The central venous catheter was removed in seven individuals. Nine patients were treated with a variety of antimicrobial agents including quinupristin-dalfopristin, chloramphenicol, doxycycline, oral bacitracin, co-trimoxazole, and nitrofurantoin. Bacteremia resolved without adverse sequelae in seven patients. Two individuals who died of other causes had persistent or relapsed bacteremia at the time of death. An additional patient suffered multiple relapses of VRE bacteremia and died as a result of VRE endocarditis 605 days following PBSCT. Mortality as a direct result of VRE bacteremia was 10% in this series. The optimal type and duration of treatment of VRE bacteremia has not been clearly defined. Therefore, we perform weekly stool surveillance cultures for VRE in our hospitalized transplant population and apply strict barrier precautions in those individuals in whom stool colonization has been identified. Furthermore, the empiric use of vancomycin has been restricted. Bone Marrow Transplantation (2000) 25, 147-152.

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Enterococci Resistant to Multiple Antimicrobial Agents, Including Vancomycin: Establishment of Endemicity in a University Medical Center

Cited by 459 publications

References 0 publications

Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil

Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil

Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models

Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation

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