Vancomycin-Resistant Enterococcus (VRE) Transmission and Risk Factors in Contacts of VRE Carriers

Kaki, Reham; Yu, Yang; O’Neill, Cindy; Lee, Christine; Mertz, Dominik; Team, Control

doi:10.1086/676864

Cited by 20 publications

(9 citation statements)

References 10 publications

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“…Carriers, healthcare workers, and environmental surfaces provide a large “silent” reservoir for transmission [12, 41, 42]. As a result, the prevalence of intra- and interhospital transmissions are likely to be much higher than reported here.…”

Section: Discussionmentioning

confidence: 96%

Complex Routes of Nosocomial Vancomycin-Resistant Enterococcus faecium Transmission Revealed by Genome Sequencing

Raven

Gouliouris

Brodrick

et al. 2017

Clinical Infectious Diseases

105

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Section: Discussionmentioning

confidence: 96%

Complex Routes of Nosocomial Vancomycin-Resistant Enterococcus faecium Transmission Revealed by Genome Sequencing

Raven

Gouliouris

Brodrick

et al. 2017

Clinical Infectious Diseases

105

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“…The number of rectal cultures required to consider a known carrier or contact patient VRE-negative, is unclear. Studies show that the sensitivity of a single rectal swab is low, ranging from 42,5% to 79% (14)(15)(16)(17), and this increases when taking multiple swabs: Pearman et al…”

Section: Discussionmentioning

confidence: 99%

Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014-2017: successful control using a restrictive screening strategy

Weterings

Oosten

Nieuwkoop

et al. 2021

Preprint

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BackgroundThe emergence of vancomycin resistant enterococci poses a major problem in healthcare settings. Here we describe a hospital-wide outbreak of vancomycin-resistant Enterococcus faecium in a general hospital in The Netherlands in the period December 2014 – February 2017. Due to late detection of the outbreak, a large cohort of approximately 25,000 (discharged) patients was classified as ‘VRE suspected’. Hereupon a mitigated screening and isolation policy, as compared with the national guideline, was implemented to control the outbreak. MethodsAfter the outbreak was identified, a screening policy consisting of a single rectal swab culture (with enrichment broth) to discontinue isolation and removing ‘VRE suspected’ label in the electronic patient files for readmitted VRE suspected patients, was implemented. In addition to the on admission screening, periodic hospital-wide point prevalence screening, measures to improve compliance with standard infection control precautions and enhanced environmental cleaning were implemented to control the outbreak.ResultsBetween September 2014 and February 2017, 140 patients were identified to be colonised by vanA mediated vancomycin-resistant Enterococcus faecium (VREfm). Two of these patients developed bacteraemia. AFLP typing showed that the outbreak was caused by a single clone. Extensive environmental contamination was found in multiple wards. Within nine months after the detection of the outbreak no new VRE cases were detected.ConclusionWe implemented a control strategy based on targeted screening and isolation in combination with implementation of general precautions and environmental cleaning. The strategy was less stringent than the Dutch national guideline for VRE control. This strategy successfully controlled the outbreak, while it was associated with a reduction in the number of isolation days and the number of cultures taken.

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“…VRE is an epidemiologically important pathogen due to increasing prevalence of antibiotic-resistant strains. Since the pharmacological treatment options are limited, contact precautions should be implemented in VRE colonized and infected patients [18]. This article describes a silent outbreak of VRE-fm in an NICU of a tertiary municipal hospital.…”

Section: Discussionmentioning

confidence: 99%

A silent outbreak of vancomycin-resistant Enterococcus faecium in a neonatal intensive care unit

Marom

Mandel

Haham

et al. 2020

Antimicrob Resist Infect Control

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Objective: To describe the containment of a widespread silent outbreak of vancomycin-resistant Enterococcus faecium (VRE-fm) in the Tel-Aviv Medical Center (TASMC) neonatal intensive care unit (NICU). Methods: Setting-an NICU, participants-49 cases of VRE-fm-colonized neonatal inpatients. Results: A newborn was transferred from the TASMC NICU to another hospital and screened positive for VRE-fm upon arrival. All TASMC NICU patients were then immediately screened for VRE and 21/38 newborns were identified as VRE carriers. Interventional measures were strictly enforced. By the end of the outbreak, 49 cases of VRE carriage had been identified. There were no VRE clinical infections. The source of the outbreak was not identified. Conclusion: Our study highlights the importance of screening implementation in a NICU setting since this outbreak could have been prevented by active screening of all out-born transfer patients and by having adopted mandatory screening into the NICU's routine procedures. Screening for multi-drug resistant organisms upon admission of all transferred patients to the NICU has been implemented.

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Vancomycin-Resistant Enterococcus (VRE) Transmission and Risk Factors in Contacts of VRE Carriers

Cited by 20 publications

References 10 publications

Complex Routes of Nosocomial Vancomycin-Resistant Enterococcus faecium Transmission Revealed by Genome Sequencing

Complex Routes of Nosocomial Vancomycin-Resistant Enterococcus faecium Transmission Revealed by Genome Sequencing

Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014-2017: successful control using a restrictive screening strategy

A silent outbreak of vancomycin-resistant Enterococcus faecium in a neonatal intensive care unit

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