Rectal colonization with vancomycin- resistant enterococci among high-risk patients in an Israeli hospital

Mercola, Dan; Poch, F.; Leibson, L.; Smetana, Samuel; Priel, Israel E.

doi:10.1053/jhin.1998.0641

Cited by 23 publications

(19 citation statements)

References 14 publications

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“…faecium isolates which is higher than 31.4% resistance rates reported from Hong Kong [5] and 66.7% in Gaza [29]. However, similar to 87.5% resistance rate reported from Israel among high risk patients [31] and comparable to 82% resistant rate reported from Iran [32]. All E. faecalis and E .…”

Section: Discussionsupporting

confidence: 59%

Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia

2015

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BackgroundMulti-drug-resistant Enterococci colonizing the intestinal tract of hospitalized patients are the major source of infection as well as nosocomial spread. Despite worldwide increasing rate of multidrug resistant Enterococci colonization and infection among hospitalized patients, there is scarcity of data from resource limited setting. The present study aimed at determining the antimicrobial resistance profile of Enterococcus species from intestinal tracts of hospitalized patients in Jimma, Ethiopia.MethodsThe study was conducted among hospitalized patients at Jimma University Specialized Hospital, from January to July 2013. Fecal samples were collected and processed for bacterial isolation and susceptibility testing to antimicrobial agents. Stool samples were inoculated onto enterococcus selective media (Bile Esculin azide agar plate) with and without 6 µg/ml of vancomycin. The isolates were identified to genus and species level by cultural characteristics, Gram’s stain, catalase test, growth in 6.5% NaCl broth, growth at 45°C, motility test and by using API 20 Streptococcus system. Sensitivity testing was done using Kirby–Bauer disk diffusion method. Minimum inhibitory concentrations for vancomycin were determined using E-test strips.ResultOverall, Enterococci were isolated from 114 (76%) of the study subjects. The isolates were Enterococcus faecium (35.1%) followed by Enterococcusfaecalis (29.8%), Enterococcus gallinarum (17.5%), Enterococcuscasseliflavus (8.8%) and Enterococcusdurans (8.8%). Among 114 tested Enterococci isolates, 41 (36%) were resistant to ampicillin, 62 (54.4%) to streptomycin and 39 (34.2%) to gentamycin. Other alternative antibiotics to treat mixed nosocomial infection caused by Enterococci also showed high rate of resistance in vitro: ciprofloxacin (50% of resistance), norfloxacin (49.1%), erythromycin (63.2%), tetracycline (64.9%), chloramphenicol (34.2%), and nitrofrantoin (32.4%). Multiple drug resistance was observed among 89.5% of E. faecium and E. faecalis. Vancomycin resistant Enterococci were observed in 5% of E. faecium isolates.ConclusionThis study reveals high rate of fecal colonization by multidrug-resistant Enterococci and prevalence of vancomycin resistance strains. Thus periodic surveillance of antibacterial susceptibilities is recommended to detect emerging resistance and to prevent the spread of antibacterial-resistant strains.

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Section: Discussionsupporting

confidence: 59%

Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia

2015

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“…Many studies are potentially confounded by high rates of nosocomial acquisition of VRE, such that differentiation between the factors associated with endogenous emergence, amplification of previously undetectable colonization, or nosocomial spread of VRE has proved difficult. As a result, published rates of colonization with VRE among patients managed in acute-care hospitals appear to vary widely between countries and have variably suggested an association between the acquisition of VRE and recent use of antibiotics, especially vancomycin and/or broad-spectrum cephalosporins (6,8,23,31,32,35). However, only a few of these studies have been prospective, and most have had some methodological flaws (19).…”

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confidence: 99%

Risk Factors for New Detection of Vancomycin-Resistant Enterococci in Acute-Care Hospitals That Employ Strict Infection Control Procedures

Padiglione

Wolfe

Grabsch

et al. 2003

Antimicrob Agents Chemother

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Accurate assessment of the risk factors for colonization with vancomycin-resistant enterococci (VRE) among high-risk patients is often confounded by nosocomial VRE transmission. We undertook a 15-month prospective cohort study of adults admitted to high-risk units (hematology, renal, transplant, and intensive care) in three teaching hospitals that used identical strict infection control and isolation procedures for VRE to minimize nosocomial spread. Rectal swab specimens for culture were regularly obtained, and the results were compared with patient demographic factors and antibiotic exposure data. Compliance with screening was defined as "optimal" (100% compliance) or "acceptable" (minor protocol violations were allowed, but a negative rectal swab specimen culture was required within 1 week of becoming colonized with VRE). Colonization with VRE was detected in 1.56% (

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“…Following this recommendation had probably led to a reduction in the prevalence of VRE carriage in central Israel HD units (4 carriers out of 92 HD patients in 1997 vs. 1 out of 105 HD patients in 2003, p = 0.1) [7]. …”

Section: Discussionmentioning

confidence: 99%

“…It has already been reported that VRE colonization and ESBL organism colonization each amplifies significantly the morbidity and the mortality rates of carriers [1, 7, 10]. Isolation of these organisms necessitates eradication since colonization is tightly related to later bacteremias and death [1, 5, 10].…”

Section: Discussionmentioning

confidence: 99%

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Serious Consequences to the Use of Cephalosporins as the First Line of Antimicrobial Therapy Administered in Hemodialysis Units

Marchaim

Lazarovitch²,

Efrati³

et al. 2005

Nephron Clin Pract

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Background: The dramatic spread of vancomycin-resistant enterococci (VRE) among hemodialysis (HD) patients led to the replacement of vancomycin with cephalosporins as part of the primary empiric therapy for bacterial infections in HD units. The aim of the study was to examine the effects of this new regimen on the colonization rate of resistant bacteria among HD patients. Methods: Rectal swabs were taken from 105 HD patients and 91 control hospitalized patients. Groups were matched for age, sex, nursing home residency and background diseases. Enterococci were tested for vancomycin resistance, Staphylococcus aureus isolates were tested for methicillin resistance (MRSA), and Enterobacteriaceae were tested for extended-spectrum β-lactamase (ESBL) activity. Results: In the HD group 1 VRE, 1 MRSA and 9 ESBL-producing organisms were isolated compared to 1 MRSA and 1 ESBL organism in the control group (p = 0.018 for ESBL). In the year prior to the study, the use of cephalosporins had been enhanced in the HD group compared to the control group (p < 0.001), and in the HD ESBL-positive patients compared to the HD ESBL-negative ones (p = 0.007). The overall use of antibiotics in the control group was the same as in the HD group. In a subanalysis of the HD group alone, the ESBL carriers were older, sicker, used more antibiotics, were hospitalized frequently and had a higher mortality rate, compared to noncarriers. Conclusions: The use of cephalosporins as first-line therapy in HD patients in central Israel reduced the prevalence of VRE colonization but may have contributed to the emergence of ESBL-producing organisms through induction of selection pressure. This may lead to serious complications in the management of these patients.

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Rectal colonization with vancomycin- resistant enterococci among high-risk patients in an Israeli hospital

Cited by 23 publications

References 14 publications

Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia

Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia

Risk Factors for New Detection of Vancomycin-Resistant Enterococci in Acute-Care Hospitals That Employ Strict Infection Control Procedures

Serious Consequences to the Use of Cephalosporins as the First Line of Antimicrobial Therapy Administered in Hemodialysis Units

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