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

Abstract

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.

Draft Genome Sequence of Vancomycin-Resistant Enterococcus faecium UEL170 (Sequence Type 412), Isolated from a Patient with Urinary Tract Infection in a Tertiary Hospital in Southern Brazil

“…In this institution, vancomycin-resistant enterococci (VRE) that were detected in surveillance rectal swab cultures from patients housed in intensive care units were first reported in 2002; the first outbreak of VRE (predominantly E. faecium [VRE fm ]) occurred in 2005 (12), and it remains among the leading Gram-positive bacteria isolated from HAI (13). Here, we describe the draft genome of the VRE fm UEL170 strain, which was isolated from an inpatient with a urinary tract infection in 2007.…”

Enterococcus spp. resistentes à vancomicina: características clínicas e fatores de risco

“…Jones et al (2013), num estudo multicêntrico realizado em países da América Latina, relatou 27% de resistência à vancomicina em amostras de Enterococcus spp., isoladas de pacientes brasileiros. Em Londrina, em maio de 2002, foi constatado um surto por E. faecium nas UTI do HU de Londrina (PERUGINI et al, 2011).…”

Patient contact is the main risk factor for vancomycin-resistant Enterococcus contamination of healthcare workers’ gloves and gowns in the intensive care unit

“…Healthcare workers (HCWs) serve as intermediate vectors for VRE transmission from patient to patient in the ICU. Previous research has implicated both the ICU room environment 6 – 8 and direct patient contact in VRE acquisition among HCWs 9 10 However, these studies were either too small or examined a number of multidrug-resistant organisms so that specific care activities related to VRE transmission could not be identified.…”