Vancomycin-resistant Enterococcus faecium on a pediatric oncology ward: duration of stool shedding and incidence of clinical infection

Henning, Kelly J.; Delencastre, Herminia; Eagan, Janet; Boone, Natalie; Brown, Arthur E.; Chung, Marilyn; Wollner, Norma; Armstrong, Donald

doi:10.1097/00006454-199610000-00004

Cited by 101 publications

(70 citation statements)

References 32 publications

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“…Not all individuals who are colonized with ARB are persistently colonized; common wisdom holds that humans may be persistent, intermittent, or noncarriers of various strains of bacteria (30). Some qualitative information about persistence times are available for MRSA (31)(32)(33)(34), VRE (5,(35)(36)(37), Escherichia coli, (38), Pseudomonas aeruginosa (39), Klebsiella pneumoniae (40,41), and other enterobacteria (42). These studies suggest that carriage for months or years is not uncommon.…”

Section: Discussionmentioning

confidence: 99%

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Smith

Dushoff

Perencevich

et al. 2004

Proc. Natl. Acad. Sci. U.S.A.

173

116

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Infections with antibiotic-resistant bacteria (ARB) in hospitalized patients are becoming increasingly frequent despite extensive infection-control efforts. Infections with ARB are most common in the intensive care units of tertiary-care hospitals, but the underlying cause of the increases may be a steady increase in the number of asymptomatic carriers entering hospitals. Carriers may shed ARB for years but remain undetected, transmitting ARB to others as they move among hospitals, long-term care facilities, and the community. We apply structured population models to explore the dynamics of ARB, addressing the following questions: (i) What is the relationship between the proportion of carriers admitted to a hospital, transmission, and the risk of infection with ARB? (ii) How do frequently hospitalized patients contribute to epidemics of ARB? (iii) How do transmission in the community, long-term care facilities, and hospitals interact to determine the proportion of the population that is carrying ARB? We offer an explanation for why ARB epidemics have fast and slow phases and why resistance may continue to increase despite infection-control efforts. To successfully manage ARB at tertiary-care hospitals, regional coordination of infection control may be necessary, including tracking asymptomatic carriers through health-care systems

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Section: Discussionmentioning

confidence: 99%

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Smith

Dushoff

Perencevich

et al. 2004

Proc. Natl. Acad. Sci. U.S.A.

173

116

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“…Of 33 VRE-colonized children, 8 patients (35%) cleared VRE from stool; 10 patients (43%) were persistent carriers, excreting organisms for 19 to 331 days (median, 112 days); and 5 patients had an insufficient number of stools to determine duration of carriage. 13 Clinical VRE infection developed in 6 of 73 patients (annual incidence, 8.2%). 13 This is consistent with our results in liver and kidney transplant recipients that show 11.5% of liver and kidney transplant recipients colonized with VRE develop VRE infections.…”

Section: Discussionmentioning

confidence: 98%

“…13 Clinical VRE infection developed in 6 of 73 patients (annual incidence, 8.2%). 13 This is consistent with our results in liver and kidney transplant recipients that show 11.5% of liver and kidney transplant recipients colonized with VRE develop VRE infections. Whether this percentage would be less in a healthier (immunocompetent) patient population (e.g., general medical patients) is unknown.…”

Section: Discussionmentioning

confidence: 98%

“…12 Pulsed-field gel electrophoresis studies showed that in half the patients who were intermittently colonized with VRE, the same strain persisted despite 3 negative culture results over a 3-week period. 12 Henning et al 13 showed that persistent gastrointestinal colonization with VRE is common among pediatric oncology patients. Of 33 VRE-colonized children, 8 patients (35%) cleared VRE from stool; 10 patients (43%) were persistent carriers, excreting organisms for 19 to 331 days (median, 112 days); and 5 patients had an insufficient number of stools to determine duration of carriage.…”

Section: Discussionmentioning

confidence: 99%

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Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients

Patel¹

2001

Liver Transplantation

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T he natural history of vancomycin-resistant enterococcus (VRE) infection is such that VRE colonization, predominantly of the gastrointestinal tract, typically precedes infection. At Mayo Medical Center (Rochester, MN), routine aerobic bacterial throat, rectal, wound, biliary, and urinary surveillance cultures have been collected from liver transplant recipients as part of a selective bowel antibiotic decontamination program for liver transplant patients. Beginning in 1995, as a result of these surveillance cultures, VRE colonization was identified in liver and kidney transplant patients. The purpose of this study is to describe the natural history of VRE colonization in liver and kidney transplant patients. Methods Cultures for VRERoutine surveillance aerobic bacterial throat, rectal, wound, biliary, and urinary cultures have been collected from hospitalized liver transplant recipients as part of a selective bowel decontamination program for liver transplant patients since the inception of the liver transplant program at Mayo Medical Center in 1985. Surveillance cultures were originally obtained twice weekly for 1 week posttransplantation and then weekly until selective bowel decontamination was discontinued (ϳ3 weeks). Through these surveillance cultures, VRE colonization was detected in the liver transplant population.Beginning November 1995, admission and twice-weekly rectal surveillance cultures were collected from all patients admitted to the adult liver, kidney, and kidney/pancreas transplant unit. These specimens were cultured on primary sheep blood agar or subculture of enriched brain heart infusion broth to Columbia colistin-nalidixic acid (CNA) agar. Subsequent to the identification of the first patient with VRE colonization, some of these cultures were ordered as "VRE screens" and cultured on selective media, as follows. Beginning October 1995, in-house CNA agar with 16 g/mL of vancomycin was used. In June 1996, Enterococcosel agar with 8 g/mL of vancomycin (Becton Dickinson, Cockeysville, MD) was substituted. The study period extended from 1985 through December 1997. Selective Bowel DecontaminationSelective bowel decontamination was performed using a mixture of 80 mg of gentamicin, 100 mg of polymyxin E, and 2 million U of nystatin administered orally or by nasogastric tube 4 times daily, beginning at least 2 days before liver transplantation and discontinued at the time of discharge from the initial hospitalization. This regimen was resumed when patients were rehospitalized. Orabase paste (Colgate, Surgery, ‡Hepatology, and §Clinical Microbiology, Mayo Clinic and Foundation, Rochester, MN; and ʈCorixa Corporation, From the *Divisions of Infectious Diseases, †Transplantation

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“…[14][15][16] Factors associated with prolonged VRE carriage include immunocompromising conditions and concomitant antibiotic exposure. [16][17][18][19] Additionally, patients with diarrhea and uncontrolled respiratory secretions and draining wounds may pose the highest risk for transmission in the healthcare environment. The sensitivity of surveillance cultures of stool or rectal swab samples for the detecting VRE colonization is not well established.…”

Section: Vancomycin-resistant Enterococci (Vre)mentioning

confidence: 99%

Duration of Contact Precautions for Acute-Care Settings

Banach

Bearman

Barnden³

et al. 2018

Infect. Control Hosp. Epidemiol.

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purposeThis expert guidance document (EG) provides recommendations regarding discontinuation of contact precautions (CP) at the individual patient level in acute-care hospitals employing CP for 1 or more of the following organisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant Enterobacteriaceae (MDR-E), including carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum β-lactamase (ESBL)-producing organisms. This document also provides a review of the role of molecular testing in guiding decisions pertaining to duration of CP for patients with these organisms. The guidance does not address decisions regarding the initiation of CP for any specific organism.Previously published guidelines describe components of CP and identify situations in which CP should be used; currently, however, few publications address the issue of how long CP should be maintained. At the time of publication, decisions related to implementation of CP for select, endemic organisms are made by individual facilities based on factors such as institutional epidemiology, resources, organizational priorities, and previously published guidance, and these vary widely. The SHEA Guidelines Committee (GLC) selected this topic to address when CP should be discontinued for individual patients in acute-care settings that employ CP for the aforementioned organisms.Although the organisms addressed are frequently encountered in other settings (eg, nursing homes, long-term acute-care facilities, rehabilitation centers, outpatient medical care settings), additional considerations may affect the application of these recommendations outside the acute-care hospital environment. authorsThe authors consist of current and past members of the SHEA Guidelines Committee (GLC), who serve as volunteers. All authors are involved at their respective institutions in the development of policies pertaining to CP, either directly or in an advisory role. intended useSpecial-topic EG documents are developed to address areas of relatively narrow scope that lack the level of evidence required for a formal guideline but are important for the provision of safe and effective healthcare. As such, systematic grading of evidence level is not provided for individual recommendations. Each EG is based on a synthesis of limited evidence, theoretical rationale, current practices, practical considerations, the opinion of the writing group, and consideration of potential harms where applicable. Within the EG, a summary list of recommendations is provided, along with their respective rationales. We also conducted a survey of the SHEA Research Network (SRN).No EG can anticipate all situations and this EG is not meant to be a substitute for individual judgment by qualified professionals. methods Expert Guidance DevelopmentThis EG follows the process outlined in the Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents. 10 The topic of duration of CP was among those proposed and ...

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Vancomycin-resistant Enterococcus faecium on a pediatric oncology ward: duration of stool shedding and incidence of clinical infection

Cited by 101 publications

References 32 publications

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: Resistance is a regional problem

Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients

Duration of Contact Precautions for Acute-Care Settings

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