Surveillance and endemic vancomycin-resistant enterococci: some success in control is possible

Morris-Downes, M.; Smyth, E.G.; Moore, J.; Thomas, T.; Fitzpatrick, Fidelma; Walsh, John J.; Caffrey, V.; Morris, Andrew M.; Foley, Susan; Humphreys, Hilary

doi:10.1016/j.jhin.2010.01.004

Cited by 18 publications

(12 citation statements)

References 32 publications

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“…22,35,53,72,82,93,98 Most were performed in tertiary-care hospitals (n = 75), followed by secondary (n = 7), 33,35,44,47,80,88,97 primary (n = 2), 4,58 and specialty hospitals (n = 3; eg, military hospital or research institute). 57,73,74 Furthermore, 29 studies were carried out in the ICU 7,8,[19][20][21]26,28,30,43,44,48,50,52,55,[57][58][59][60]62,66,67,70,71,74,77,[88][89][90][91] ; 19 studies were conducted in wards 4,5,29...…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associatedC. difficileand multidrug-resistant organisms

Abad

Barker

Safdar

2020

Infect. Control Hosp. Epidemiol.

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Background:Cohorting of patients and staff is a control strategy often used to prevent the spread of infection in healthcare institutions. However, a comprehensive evaluation of cohorting as a prevention approach is lacking.Methods:We performed a systematic review of studies that used cohorting as part of an infection control strategy to reduce hospital-acquired infections. We included studies published between 1966 and November 30, 2019, on adult populations hospitalized in acute-care hospitals.Results:In total, 87 studies met inclusion criteria. Study types were quasi-experimental “before and after” (n = 35), retrospective (n = 49), and prospective (n = 3). Case-control analysis was performed in 7 studies. Cohorting was performed with other infection control strategies in the setting of methicillin-resistant Staphylococcus aureus (MRSA, n = 22), Clostridioides difficile infection (CDI, n = 6), vancomycin-resistant Enterococcus (VRE, n = 17), carbapenem-resistant Enterobacteriaceae infections (CRE, n = 22), A. baumannii (n = 15), and other gram-negative infections (n = 5). Cohorting was performed either simultaneously (56 of 87, 64.4%) or in phases (31 of 87, 35.6%) to help contain transmission. In 60 studies, both patients and staff were cohorted. Most studies (77 of 87, 88.5%) showed a decline in infection or colonization rates after a multifaceted approach that included cohorting as part of the intervention bundle. Hand hygiene compliance improved in approximately half of the studies (8 of 15) during the respective intervention.Conclusion:Cohorting of staff, patients, or both is a frequently used and reasonable component of an enhanced infection control strategy. However, determining the effectiveness of cohorting as a strategy to reduce transmission of MDRO and C. difficile infections is difficult, particularly in endemic situations.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associatedC. difficileand multidrug-resistant organisms

Abad

Barker

Safdar

2020

Infect. Control Hosp. Epidemiol.

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“…The wards focused on thorough cleaning of the environment surrounding the positive patient, especially the patient care equipment. Whenever it was possible, the patient was isolated in a single room (24,25).…”

Section: Rectal Carriage Of Vre/crgnmentioning

confidence: 99%

Gastrointestinal Carriage of Vancomycin-Resistant Enterococci and Carbapenem-Resistant Gram-Negative Bacteria in an Endemic Setting: Prevalence, Risk Factors, and Outcomes

Vasilakopoulou

Karakosta

Vourli

et al. 2020

Front. Public Health

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Background: Gastrointestinal carriage of vancomycin-resistant enterococci (VRE) and carbapenem-resistant Gram-negative bacteria (CRGN) constitutes a major public health concern as it may be followed by clinical infection development or lead to intra-hospital dissemination. Detection of carriers and implementation of infection control measures are essential in every hospital. In this study we determined the point prevalence of VRE and CRGN in the fecal flora of the inpatients of a tertiary university hospital in Greece. We determined risk factors for carriage and examined the impact of carriage on hospital outcomes. Materials/Methods: A point prevalence study of VRE/CRGN rectal carriage of inpatients was conducted on March 2018. Specimens were selectively cultured for VRE/CRGN, microorganisms were biochemically identified, submitted to antibiotic susceptibility testing, and tested for carbapenemase production. Data on potential risk factors and hospital outcomes were collected at the time of culture and until hospital discharge. Multivariable logistic and linear regression models were used, adjusting for confounders.Results: Four hundred ninety-one patients were enrolled in the study. Of them, 64 (13.0%) were positive for VRE carriage, 40 (8.2%) for CRGN, and 10 patients (2.1%) for both VRE and CRGN. VRE carriage was independently associated with age over 65 years (adjusted OR: 2.4 [95%CI: 1.3, 4.5]) and length of stay (LOS) before rectal sampling (OR: 1.1 [95%CI: 1.0, 1.1]). Carriage of CRGN was associated with 11 days increase of LOS after rectal sampling (β-coef: 11.4 [95%CI: 1.6, 21.2]), with a 3.5-fold increased risk of acquiring a resistant pathogen after rectal swabbing (RR: 3.5 [95%CI 1.2, 9.9]) and with a 6-fold increased risk of mortality (RR: 6.1 [95%CI: 2.1, 17.9]), after adjusting for sex, age, and comorbidity index. Vasilakopoulou et al. Gastrointestinal Carriage: Prevalence, Risk-Factors, Outcomes Conclusions: High prevalence rates were found for VRE and CRGN carriage among the inpatients of our hospital. Prolonged hospitalization and age were independent risk factors for VRE carriage, while CRGN carriage was associated with increased risk of acquiring a resistant pathogen, prolonged hospital stay, and increased mortality.

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“…In other countries rates of VRE remain at a comparably high rate such as Ireland and Portugal 5 (Novais et al, 2008;Morris-Downes et al, 2010). Decreasing rates were considered significant in countries like Italy, France, Israel and Greece; however, it has to be documented if these trends are indeed lasting and not biased by other, so far unknown factors (see EARS-Net data).…”

Section: Europementioning

confidence: 99%

Current Trends of Emergence and Spread of Vancomycin-Resistant Enterococci

Werner¹

2012

Antibiotic Resistant Bacteria - A Continuous Challenge in the New Millennium

184

229

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Surveillance and endemic vancomycin-resistant enterococci: some success in control is possible

Cited by 18 publications

References 32 publications

A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associatedC. difficileand multidrug-resistant organisms

A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associatedC. difficileand multidrug-resistant organisms

Gastrointestinal Carriage of Vancomycin-Resistant Enterococci and Carbapenem-Resistant Gram-Negative Bacteria in an Endemic Setting: Prevalence, Risk Factors, and Outcomes

Current Trends of Emergence and Spread of Vancomycin-Resistant Enterococci

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