Vancomycin-resistant enterococci carriage in an acute Irish hospital

Whelton, E.; Lynch, Caoimhe; O’Reilly, Barry; Corcoran, G.D.; Cryan, B.; Keane, S.M.; Sleator, Roy D.; Lucey, Brigid

doi:10.1016/j.jhin.2016.03.005

Cited by 18 publications

(8 citation statements)

References 20 publications

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“…A plausible explanation for this is the fact that patients treated in emergency departments most likely acquired the E. faecium infection in the community, rather than in the hospital. This interpretation is consistent with evidence from previous studies that reported a lower prevalence of vancomycin resistance among E. faecium isolates from emergency and outpatient hospital clinics compared to isolates from hospital inpatients [30,36,48]. In addition, we found that VREFm proportions significantly increased in inpatient hospital units over the years.…”

Section: Discussionsupporting

confidence: 93%

The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: an epidemiological analysis of bloodstream infections

Ayobami

Willrich

Reuß

et al. 2020

Emerging Microbes & Infections

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Vancomycin-resistant enterococci infections are of great public health significance due to limited therapeutic options. We investigated epidemiological trends and risk factors of vancomycin resistance in enterococci isolates from patients with bloodstream infections in the EU/EEA from 2012 to 2018. Routine vancomycin susceptibility data of clinical E. faecium (n = 67,022) and E. faecalis (n = 103,112) blood isolates from the European Antimicrobial Resistance Surveillance Network were analysed using descriptive statistics and multivariable regression analyses. In Europe, proportions of vancomycin-resistant E. faecium (VREFm) increased from 8.1% (95%CI 6.7-9.7%) in 2012 to 19.0% (95% CI 16.8-21.5%) in 2018. Rising VREFm proportions were observed across all European regions, both genders and all age groups except children and adolescents (1-19 years). Adults (20-59 years) and elderly (≥60 years) had an increased likelihood of VREFm compared to children and adolescents (1-19 years) (OR: 1.99 [95%CI 1.42-2.79, p < 0.001] and OR: 1.56 [95%CI 1.09-2.23, p = 0.014], respectively). Inpatients hospital units, including internal medicine and ICUs, were associated with an increased likelihood of VREFm (OR: 2.29 (95%CI 1.58-3.32, p < 0.001) compared to the emergency department which reflects patients with community origin of E. faecium infections. The mean proportion of vancomycin-resistant E. faecalis in Europe was found to be low (1.1% [95%CI 0.9-1.4%]). Local and regional authorities should intensify efforts directed at diagnostic and antimicrobial stewardship for vancomycin and all last resort drugs for the management of VREFm, particularly for hospitalized elderly patients.

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Section: Discussionsupporting

confidence: 93%

The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: an epidemiological analysis of bloodstream infections

Ayobami

Willrich

Reuß

et al. 2020

Emerging Microbes & Infections

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“…Two (50%) E. faecalis out of 4 total isolates showed a vanA genotype. A survey in the UK reported high rates of asymptomatic carriage of VRE, similar to those reported in a study based in Ireland [16]. Asymptomatic colonization of patients, particularly those who are immunocompromised, presents a risk of transmission to other patients.…”

Section: Prevalence Of Vancomycin Resistance Phenotypes Among Enterocsupporting

confidence: 67%

“…Electrophoresis gel for PCR amplification of vanA,vanB and vanC genes. L well -molecular size marker 3000 bp (Thermo Scientific); vanA positive wells: 1, 20, 21, 22, 23; vanB positive wells:2,7,8,10,11,12,13,16; vanC genes were not detected.…”

mentioning

confidence: 99%

Prevalence of vancomycin resistance phenotypes among Enterococcus species isolated from clinical samples in a Romanian hospital

2019

Biointerface Res Appl Chem

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Vancomycin resistant Enterococcus (VRE) has been increasingly reported since the 1980s. Although normally regarded as harmless commensals, enterococci can become the etiological agents of nosocomial infections causing urinary tract infections, peritonitis, bacteriemia, wound infections and endocarditis. The acquisition of vancomycin resistance has seriously affected the treatment and infection control of these bacteria. VRE are frequently resistant to most antibiotics that are effective against vancomycin susceptible enterococci, the therapeutic options of VRE infections being thus very limited. The aim of this study was to assess the genetic support of vancomycin resistance among VRE strains isolated from patients admitted to intensive care units in one hospital unit from Bucharest, Romania Out of 84 enterococcal strains isolated from urine prelevated from catheterized and non-catheterized patients with urinary tract infections, wound secretions, pus, blood, ascite liquid and stool, 28 strains had glycopeptide resistance. Out of these, in the 12 vancomycin-resistant Enterococcus faecalis strains, the VanA phenotype was detected in 9 strains and VanB in 3 strains. From the 16 E. faecium strains resistant to vancomycin, 10 strains showed the VanA phenotype and 6 strains had the VanB phenotype. According to the results of this study, the VanA phenotype, conferring high-level resistance to vancomycin and teicoplanin, was more prevalent than VanB in the Enterococcus sp. strains isolated from hospitalized patients.

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“…The strains found unrelated to both cluster 1 and 2, including the index case isolate, may have originated from patients colonized with VRE prior to the outbreak. It is unknown how long VRE is carried, but colonization could persist from weeks to months 31–33 , hence colonized patients will occasionally be admitted to hospitals and other health care institutions. However, three of the nine unrelated isolates were found in patients who had screened negative for VRE in an early phase of the outbreak, and thus the place and time for their colonization remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Molecular analysis and epidemiological typing of Vancomycin-resistant Enterococcus outbreak strains

Rangberg

Larsen

Kacelnik

et al. 2019

Sci Rep

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Outbreaks of multidrug resistant bacteria including vancomycin-resistant enterococci (VRE) in healthcare institutions are increasing in Norway, despite a low level of resistance compared to other European countries. In this study, we describe epidemiological relatedness of vancomycin-resistant Enterococcus faecium isolated during an outbreak at a Norwegian hospital in 2012–2013. During the outbreak, 9454 fecal samples were screened for VRE by culture and/or PCR. Isolates from 86 patients carrying the vanA resistance gene were characterized using pulsed-field gel electrophoresis (PFGE), MALDI-TOF mass spectrometry and single nucleotide polymorphism typing. PFGE revealed two main clusters, the first comprised 56 isolates related to an initial outbreak strain, and the second comprised 21 isolates originating from a later introduced strain, together causing two partly overlapping outbreaks. Nine isolates, including the index case were not related to the two outbreak clusters. In conclusion, the epidemiological analyses show that the outbreak was discovered by coincidence, and that infection control measures were successful. All typing methods identified the two outbreak clusters, and the experiment congruence between the MALDI-TOF and the PFGE clustering was 63.2%, with a strong correlation (r = 72.4%). Despite lower resolution compared to PFGE, MALDI-TOF may provide an efficient mean for real-time monitoring spread of infection.

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Vancomycin-resistant enterococci carriage in an acute Irish hospital

Cited by 18 publications

References 20 publications

The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: an epidemiological analysis of bloodstream infections

The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: an epidemiological analysis of bloodstream infections

Prevalence of vancomycin resistance phenotypes among Enterococcus species isolated from clinical samples in a Romanian hospital

Molecular analysis and epidemiological typing of Vancomycin-resistant Enterococcus outbreak strains

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