Nosocomial Outbreak Due to Enterococcus faecium Highly Resistant to Vancomycin, Penicillin, and Gentamicin

Handwerger, Sandra; Raucher, B.; Altarac, David; Monka, Jean; Marchione, Susan; Singh, Kavindra V.; Murray, Barbara E.; Wolff, John B.; Walters, B. A. J.

doi:10.1093/clind/16.6.750

Cited by 404 publications

(274 citation statements)

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“…The most frequent risk factors found included vancomycin use, cephalosporin use, highacuity illness, and immunosuppression. [3][4][5][6] In our study of liver transplant recipients, some of these factors were also found. However, we also identified frequent biliary tract manipulation as a risk factor, suggesting that recipients with biliary complications were at a greater risk for invasive infection.…”

Section: Discussionsupporting

confidence: 64%

“…2 Other centers have identified several risk factors for VREF infection, including empirical broad-spectrum antibiotic therapy, prolonged vancomycin therapy, prolonged hospitalization, and immunosuppression. [3][4][5][6][7] From August through November 1993, 8 liver transplant recipients developed infections with VREF in our institution. While undertaking an epidemiology study, microbiological studies were also performed.…”

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confidence: 99%

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An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients

et al. 1997

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Vancomycin-resistant Enterococcus faecium (VREF) has become a significant nosocomial pathogen for immunosuppressed patients. During a 5-month period in 1993, 8 cases of invasive infection with VREF (7 with bacteremia) were identified in liver transplant recipients, half of whom were adults. Epidemiology and microbiology studies were designed to identify the source and to determine the risk factors for this infection. Overall mortality was 50% (3 adults and 1 child). Mortality in bacteremic patients was 57%. A casecontrol study showed that cases were more likely to have been treated with a third-generation cephalosporin or vancomycin and to have undergone more than four biliary tract procedures. Environmental surveillance cultures yielded only one VREF isolate from a rectal temperature probe, but this device was used in only 2 of the cases. Cultures from all surgery and radiology suites were negative. All VREF isolates were genotyped by contour-clamped homogenous electric field electrophoresis of chromosomal DNA restriction fragments. These studies showed that a single clone was responsible for the outbreak, although other clones could be detected in the hospital. After implementing strict contact isolation on the liver transplant unit, only 1 additional patient with VREF was identified during this outbreak. In conclusion, it was found that antibiotic use and biliary tract manipulation were risk factors for developing invasive infections with VREF after liver transplantation. Optimal treatment is still unclear but most likely includes a combination of two or more antibiotics. Prompt institution of infection control measures can preclude rapid spread of this nosocomial pathogen.

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Section: Discussionsupporting

confidence: 64%

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confidence: 99%

An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients

et al. 1997

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“…Ten of 12 patients experienced VRE BSI during the neutropenic period (median 15 days post transplant, range [8][9][10][11][12][13][14][15][16][17][18][19][20][21], and mainly this occurred in patients with refractory or relapsed disease at the time of transplantation (70%). All VRE BSI patients were co-infected with other organisms including gram-negative bacilli, fungi or CMV, and five patients had intra-abdomial complications (GVHD, cholecystitis or typhlitis).…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Up to 73% of enterococcal BSIs are due to vancomycin-resistant strains. 9 Risk factors for vancomycin-resistant enterococcal (VRE) colonization and infection include prolonged hospitalization, intensive care unit (ICU) stay, advanced age, immunocompromised state, neutropenia, high severity of underlying illness, antibiotic exposure, and indwelling urinary and vascular catheters, 8,[10][11][12][13] characteristics commonly found in patients on HSCT units. Several studies have investigated the significance of VRE infections in different patient populations and controversy exists as to whether VRE infections are associated with worse outcomes compared to vancomycin-sensitive enterococci.…”

Section: Introductionmentioning

confidence: 99%

Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?

Dubberke

Hollands

Georgantopoulos

et al. 2006

Bone Marrow Transplant

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Patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients are at high risk for bacterial bloodstream infections (BSI) owing to resistant organisms. Data describing the outcomes of vancomycin-resistant enterococcal (VRE) BSI in this patient population are limited. We performed a retrospective cohort study of all cases of VRE BSI that occured between February 1996 and December 2002 on the Leukemia/HSCT unit at Barnes-Jewish Hospital. There were 68 episodes of VRE BSI in 60 patients with acute (53%) or chronic (8%) leukemia, non-Hodgkin's lymphoma (22%) or other malignant hematologic disorders (17%). A total of 13, 32 and 32% were recipients of autologous, related and matched-unrelated transplants, respectively. Forty-two of allograft recipients had active acute graft-versus-host disease (GVHD) and 32% chronic GVHD. Only 57% were neutropenic, 52% had refractory/relapsed malignancy and 60% had end organ dysfunction with a median APACHE II score of 17. Median survival after VRE BSI was 19 days. Pneumonia, receipt of anti-fungal drugs and low APACHE II score at the time of the VRE BSI remained significant risk factors for death on multivariable analysis. Our analysis suggests that in patients with hematological malignancies or HSCT, VRE may not have the behavior of a virulent pathogen. VRE BSI may simply be a marker of these patients' already existing critical medical condition.

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“…Similar results were obtained in some US hospitals. 13,14 As seen in some other studies, microorganisms of HAI have more resistant profile than community acquired infection. 15 Majority of the isolated organisms were found sensitive to Tetracyclines and Chloramphenicol, which are not routinely prescribed these days.…”

Section: Discussionmentioning

confidence: 79%

Antimicrobial use and antimicrobial resistance in nosocomial pathogens at a tertiary care hospital in Pune

Nair

Sharma

Sahni³

et al. 2015

Medical Journal Armed Forces India

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a b s t r a c tBackground: Resistance to antimicrobial agents is emerging in wide variety of nosocomial and community acquired pathogens. Widespread and often inappropriate use of broad spectrum antimicrobial agents is recognized as a significant contributing factor to the development and spread of bacterial resistance. This study was conducted to gain insight * Corresponding author.E-mail address: nairvelu2000@yahoo.com (V. Nair).Available online at www.sciencedirect.com Keywords:Hospital acquired infection Antibiotic sensitivity Antifungal sensitivity MicroorganismsAntimicrobial use into the prevalent antimicrobial prescribing practices, and antimicrobial resistance pattern in nosocomial pathogens at a tertiary care hospital in Pune, India.Methods: Series of one day cross sectional point prevalence surveys were carried out on four days between March and August 2014. All eligible in patients were included in the study. A structured data entry form was used to collect the data for each patient. Relevant samples were collected for microbiological examination from all the clinically identified hospital acquired infection cases.Results: 41.73% of the eligible patients (95% CI: 39.52e43.97) had been prescribed at least one antimicrobial during their stay in the hospital. Beta-lactams (38%) were the most prescribed antimicrobials, followed by Protein synthesis inhibitors (24%). Majority of the organisms isolated from Hospital acquired infection (HAI cases) were found to be resistant to the commonly used antimicrobials viz: Cefotaxime, Ceftriaxone, Amikacin, Gentamicin and Monobactams.Conclusion: There is need to have regular antimicrobial susceptibility surveillance and dissemination of this information to the clinicians. In addition, emphasis on the rational use of antimicrobials, antimicrobial rotation and strict adherence to the standard treatment guidelines is very essential.

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Nosocomial Outbreak Due to Enterococcus faecium Highly Resistant to Vancomycin, Penicillin, and Gentamicin

Cited by 404 publications

References 0 publications

An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients

An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients

Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?

Antimicrobial use and antimicrobial resistance in nosocomial pathogens at a tertiary care hospital in Pune

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