Outbreak of vanB vancomycin-resistant Enterococcus faecium colonization in a neonatal service

Lister, D.; Kotsanas, Despina; Ballard, Susan A; Howden, Benjamin P; Carse, Elizabeth; Tan, Kenneth; Scott, Carmel; Gillespie, Elizabeth; Mahony, Andrew A; Doherty, Richard; Korman, Tony M.; Johnson, Paul D R; Stuart, Rhonda L.

doi:10.1016/j.ajic.2015.05.047

Cited by 29 publications

(29 citation statements)

References 16 publications

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“…Thus, this strongly underscores the essential importance of adequate staff-patient ratios as constituted by the national guidelines1618. Noticeably, when compared to most reports on microbial outbreaks on NICUs that usually describe one specifically causative pathogen262728 the here described outbreak involved multiple different organisms. Furthermore, this outbreak was unusually long-lasting covering a period of almost 9 months.…”

Section: Discussionmentioning

confidence: 65%

Nursing staff fluctuation and pathogenic burden in the NICU - effective outbreak management and the underestimated relevance of non-resistant strains

Hensel

Bruck

Klare

et al. 2017

Sci Rep

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In the course of a hospital management takeover, a microbial outbreak took place in a tertiary neonatal intensive care unit (NICU). Here, we characterize the outbreak and its management. About 4 months prior to takeover, there was a sharp increase in positive isolates for MSSA and multidrug-resistant organisms (MDROs). Simultaneously, the nursing staff sick leave rate increased dramatically which directly correlated with the number of infection/colonization per week (r2 = 0.95, p = 0.02). During the following months we observed several peaks in positive isolates of methicillin-sensitive staphylococcus aureus (MSSA), MDROs and subsequently a vancomycin-resistant enterococcus (VRE) outbreak. Interventional outbreak management measures were only successful after substantial recruitment of additional nursing staff. None of the VRE, but 44% (n = 4) of MDRO and 32% (n = 23) of MSSA colonized infants developed symptomatic infections (p = 0.02). Among the latter, 35% suffered from serious consequences such as osteomyelitis. The most important risk factors for colonization-to-infection progression were low gestational age and birth weight. Nursing staff fluctuation poses a substantial risk for both bacterial colonization and infection in neonates. Comprehensive outbreak management measures are only successful if adequate nursing staff is available. Non resistant strains account for most neonatal infections – possibly due to their limited perception as being harmful.

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Section: Discussionmentioning

confidence: 65%

Nursing staff fluctuation and pathogenic burden in the NICU - effective outbreak management and the underestimated relevance of non-resistant strains

Hensel

Bruck

Klare

et al. 2017

Sci Rep

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“…Whereas outbreaks of VanB-type VREfm have been described before (24)(25)(26), this study reports, to the best of our knowledge, the largest outbreak with this organism so far, comprising more than 500 isolates and dominated by a VanB-type ST80 VREfm. In this study, we developed an approach to combine NGS data with epidemiological data from 773 patients, allowing the elucidation of the outbreak dynamic on a single-patient basis.…”

Section: Id395 (Unk) Id571 (H) Id495 (O) Id628 (J) Id617 (Q) Id735 (Jmentioning

confidence: 66%

Expansion of Vancomycin-Resistant Enterococcus faecium in an Academic Tertiary Hospital in Southwest Germany: a Large-Scale Whole-Genome-Based Outbreak Investigation

Liese

Schüle

Oberhettinger

et al. 2019

Antimicrob Agents Chemother

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Vancomycin-resistant Enterococcus faecium (VREfm) is a frequent cause of nosocomial outbreaks. In the second half of 2015, a sharp increase in the incidence of VREfm was observed at our university medical center. Next-generation sequencing (NGS) was used to analyze the first isolates of VREfm recovered from patients between 2010 and 2016 (n = 773) in order to decipher epidemiological change, outbreak dynamics, and possible transmission routes. VREfm isolates were analyzed using whole-genome sequencing followed by sequence type extraction and phylogenetic analysis. We examined epidemiological data, room occupancy data, and patient transferals and calculated an intensity score for patient-to-patient contact. Phylogenetic analysis revealed the presence of 38 NGS clusters and 110 single clones. The increase of VREfm was caused mainly by the expansion of two newly introduced NGS clusters, comprising VanB-type strains determined by multilocus sequence typing (MLST) as sequence type 80 (ST80) and ST117. By combining phylogenetic information with epidemiological data, intrahospital transmission could be demonstrated, however to a lesser extent than initially expected based solely on epidemiological data. The outbreak clones were continuously imported from other hospitals, suggesting a change in the epidemiological situation at a regional scale. By tracking intrahospital patient transferals, two major axes could be identified that contributed to the spread of VREfm within the hospital. NGS-based outbreak analysis revealed a dramatic change in the local and regional epidemiology of VREfm, emphasizing the role of health care networks in the spread of VREfm.

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“…However, this approach is expensive and cumbersome, particularly when VRE endemicity is high. Because of the relatively low virulence of VRE, other facilities rely on standard precautions, predominantly alcohol-based hand rub usage, and only selectively perform active surveillance cultures in high-risk areas such as hematology departments and intensive care units (15). At Austin Health and Monash Medical Centre, two university teaching hospitals in Melbourne, Australia, patients are screened for VRE rectal colonization on admission and weekly for all inpatients in defined high-risk clinical areas.…”

Section: Introductionmentioning

confidence: 99%

Increasing tolerance of hospital Enterococcus faecium to handwash alcohols

et al. 2018

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Alcohol-based disinfectants and particularly hand rubs are a key way to control hospital infections worldwide. Such disinfectants restrict transmission of pathogens, such as multidrug-resistant and Despite this success, health care infections caused by are increasing. We tested alcohol tolerance of 139 hospital isolates of obtained between 1997 and 2015 and found that isolates after 2010 were 10-fold more tolerant to killing by alcohol than were older isolates. Using a mouse gut colonization model of transmission, we showed that alcohol-tolerant resisted standard 70% isopropanol surface disinfection, resulting in greater mouse gut colonization compared to alcohol-sensitive We next looked for bacterial genomic signatures of adaptation. Alcohol-tolerant accumulated mutations in genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed the roles of these genes in the tolerance of to isopropanol. These findings suggest that bacterial adaptation is complicating infection control recommendations, necessitating additional procedures to prevent from spreading in hospital settings.

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Outbreak of vanB vancomycin-resistant Enterococcus faecium colonization in a neonatal service

Cited by 29 publications

References 16 publications

Nursing staff fluctuation and pathogenic burden in the NICU - effective outbreak management and the underestimated relevance of non-resistant strains

Nursing staff fluctuation and pathogenic burden in the NICU - effective outbreak management and the underestimated relevance of non-resistant strains

Expansion of Vancomycin-Resistant Enterococcus faecium in an Academic Tertiary Hospital in Southwest Germany: a Large-Scale Whole-Genome-Based Outbreak Investigation

Increasing tolerance of hospital Enterococcus faecium to handwash alcohols

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