High-level vancomycin-resistant enterococci causing hospital infections

Uttley, A.H.C.; George, R.C.; Naidoo, Jay; Woodford, Neil; Johnson, Alan P.; Collins, C.H.; Morrison, Donald A.; Gilfillan, A; Fitch, L E; Heptonstall, J

doi:10.1017/s0950268800030478

Cited by 315 publications

(200 citation statements)

References 27 publications

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“…Although Uttley et al 17 found that most resistant strains remained sensitive to other drugs such as ampicillin and ciprofloxacin, other reports had suggested the occurrence of multi-resistant organisms. The isolation of truly multiresistant organisms from two of our patients is a cause for concern.…”

Section: Discussionmentioning

confidence: 98%

High-Level, Multiresistant Enterococci Associated with Systemic Disease: A Report of Two Cases

et al. 1996

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SMH Qadri, ME Ellis, F Al-Rabiah, P Ernst, S Ingemansson, High-Level, Multiresistant Enterococci Associated with Systemic Disease: A Report of Two Cases. 1996; 16(6): 682-685 We describe two patients who died from enterococcal systemic disease. The organisms were identified as Enterococcus faecium. One isolate was resistant to all available antimicrobials and the other was sensitive only to chloramphenicol. The recent emergence of multiple-resistant enterococcal species reflects the critically fragile status of antimicrobial therapeutics. The clinical implications and possible means of their control are discussed.Although the term "enterocoque" was first used almost 100 years ago to emphasize the intestinal origin of these bacteria, 1 until recently they were classified in the genus Streptococcus, mainly because of their morphological resemblance and common biochemical tests. However, in 1984 it was shown by nucleic acid hybridization studies that S. faecalis and S. faecium were so distantly related to streptococci that they should be transferred to a new genus called Enterococcus.2 These bacteria also differ significantly in their antimicrobial susceptibility patterns from other streptococci. Recently these organisms have drawn much attention, not only because of their increasing role in hospital-acquired infections but because of their increasing resistance to antimicrobial agents. Their intrinsic resistance or relative resistance to β-lactams, clindamycin and aminoglycosides, and ability to acquire resistance to ciprofloxacin, erythromycin and tetracycline is well known.3-6 The most recent and most disturbing trait to emerge is resistance to vancomycin.7 Three years ago we had reported the first case of wound infection caused by vancomycin-resistant Enterococcus.7 In this paper we report two cases in which multiresistant enterococci were associated with systemic disease. Case 1A 15-year-old male patient with acute myelogenous leukemia and neutropenia developed fever and was treated with ceftazidime 40 mg/kg q8h intravenously, amikacin 15 mg/kg daily, vancomycin 15 mg/kg q12h and amphotericin B 0.5 mg/kg daily for four weeks. He eventually defervesced, but no organisms were isolated. He then received a regimen which included busulphan and total body irradiation for refractory relapsed acute leukemia prior to bone marrow transplantation. Although he was afebrile at the time of transplantation, he was profoundly neutropenic with a white count of <0.1 x 10 9 /L, and was therefore continued on the same broad spectrum antimicrobials. On the sixth day after the bone marrow transplant, he again became febrile; blood cultures taken 14 days post-transplantation grew Enterococcus, which was identified as E. faecium. Clinical management included catheter and line change, with the administration of imipenem 20 mg/kg q6h intravenously. The patient continued to be unwell, developing peritonitis and right lower lobe pneumonia in the presence of persistent neutropenia. Bone marrow examination showed a hypocellular marrow....

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Section: Discussionmentioning

confidence: 98%

High-Level, Multiresistant Enterococci Associated with Systemic Disease: A Report of Two Cases

et al. 1996

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“…6 " 11 In 1994, three more publications described outbreaks of VRE. 1214 These studies during the first 5 years of the VRE epidemic (1989)(1990)(1991)(1992)(1993)(1994) began to define the epidemiology of VRE colonization and infection and led to the following conclusions:…”

Section: Glen Mayhall MDmentioning

confidence: 99%

The Epidemiology and Control of VRE: Still Struggling to Come of Age

Mayhall

1999

Infect. Control Hosp. Epidemiol.

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“…5 One of the first descriptions of vancomycin resistant enterococci (VRE) was in patients with end stage renal disease (ESRD) by Uttley et.al. 6 Risk factors for VRE colonization include host characteristics (immunosuppression, renal insufficiency and neutropenia), hospital factors (admission in an ICU or oncology ward) proximity to a VRE colonized patient, and extended duration of hospitalization and antimicrobial use. 7 VRE colonization independently increases a patient's risk of developing enterococcal infections, such as bloodstream infections (BSIs).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, dialysis patients also have contributory underlying co-morbid conditions, frequent hospitalizations and antibiotic exposures which predispose them to colonization with VRE. 6 Since VRE colonization is a critical risk factor, the optimal method for preventing clinical infections is to prevent colonization. Once a patient becomes colonized with VRE, it is important to recognize modifiable risk factors that contribute to the development of infection in a colonized patient.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study of Antibiotic Resistance and Virulence Factors in Enterococci Isolated From Patients With End Stage Renal Disease

Tellis

Muralidharan²

2012

Int Jour of Biomed Res

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Introduction and objectives:Patients with end stage renal disease (ESRD) are at risk for colonization and infections with multidrug resistant (MDR) enterococci, which are a formidable challenge to treat. This study aims to speciate enterococci isolated from ESRD patients; determine their antibiogram and virulence factors. Methods: 50 isolates of enterococci obtained from ESRD patients were studied. Rectal swabs were screened for gastrointestinal VRE colonisation. Sample collection, processing and antibiotic susceptibility testing were performed according to standard guidelines. Vancomycin resistant enterococci (VRE) were characterized based on vancomycin MIC as VanA, VanB and VanC phenotypes. Presence of vanA and vanB genes was confirmed by polymerase chain reaction. Haemolysin, gelatinase, beta-lactamase and biofilm production were detected using standard methods. Results: out of the 50 isolates of enterococci 28(56%) were E.faecalis, 21(42%) E.faecium and 1(2%) was E.gallinarum. 12 isolates (E.faecium 33.33% and E.faecalis 17.85%) showed vancomycin resistance, of which 9 were VanA, 2 VanB and 1 VanD phenotype. 22(44%) isolates produced haemolysin, 16(32%) gelatinase, 19(38%) beta-lactamase and 12(24%) produced biofilms. 10/12(83.3%) patients with VRE infection showed gastrointestinal colonization with the same. Interpretation & conclusion: Colonization and infection caused by MDR enterococci and VRE are a significant clinical problem in patients with ESRD. Judicious use of vancomycin, careful screening and infection control precautions should be practiced to limit the transmission of VRE.

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High-level vancomycin-resistant enterococci causing hospital infections

Cited by 315 publications

References 27 publications

High-Level, Multiresistant Enterococci Associated with Systemic Disease: A Report of Two Cases

High-Level, Multiresistant Enterococci Associated with Systemic Disease: A Report of Two Cases

The Epidemiology and Control of VRE: Still Struggling to Come of Age

A Prospective Study of Antibiotic Resistance and Virulence Factors in Enterococci Isolated From Patients With End Stage Renal Disease

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