An Outbreak of Vancomycin-ResistantEnterococcus faeciumin an Acute Care Pediatric Hospital: Lessons from Environmental Screening and a Case-Control Study

Steven J Drews,Renee Freeman,Derek Stevens,Carol Goldman,Cristina Goia,Susan E Richardson,Laurie Streitenberger,Rick Wray,Anne G Matlow,Jason Brophy,Danuta Kovach

doi:10.1155/2008/727062

Abstract

The present study describes a vancomycin-resistant enterococci (VRE) outbreak investigation and a case-control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital. To report an outbreak investigation and a case-control study to identify risk factors for VRE colonization or infection in hospitalized children. Screening for VRE cases was performed by culture or polymerase chain reaction. A case-control study of VRE-colonized patients was undertaken. Environmental screening was performed using standard culture and susceptibility methods, with pulsed-field gel electrophoresis to determine relationships between VRE isolates. Statistical analysis was performed using SAS version 9.0 (SAS Institute Inc, USA). Thirty-four VRE-positive cases were identified on 10 wards between February 28, 2005, and May 27, 2005. Pulsed-field gel electrophoresis analysis confirmed a single outbreak strain that was also isolated from a video game found on one affected ward. Multivariate analysis identified cephalosporin use as the major risk factor for VRE colonization. In the present study outbreak, VRE colonization was significantly associated with cephalosporin use. Because shared recreational items and environmental surfaces may be colonized by VRE, they warrant particular attention in housekeeping protocols, particularly in pediatric institutions.

Highlights

The present study describes a vancomycinresistant enterococci (VRE) outbreak investigation and a case-control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital
Epidemiological and microbiological characteristics Following the identification of the index case of VRE on a hematology-oncology ward, 33 patients who had been hospitalized on 10 wards were further identified between February 28, 2005, and May 27, 2005 (Figure 1)
The present study is the first published description of a VRE outbreak investigation in a Canadian pediatric acute care institution, reports in children’s hospitals have been reported worldwide. Similar to this outbreak, which was first identified in a hematology-oncology population, most previously described outbreaks and surveillance studies of VRE in pediatric hospitals have identified hematology-oncology patients as key reservoirs of VRE; reports of outbreaks in children in neonatal intensive care units have been reported [4,5,11,12]

Summary

Introduction

The present study describes a vancomycinresistant enterococci (VRE) outbreak investigation and a case-control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital. OBJECTIVE: To report an outbreak investigation and a case-control study to identify risk factors for VRE colonization or infection in hospitalized children. METHODS: Screening for VRE cases was performed by culture or polymerase chain reaction. Environmental screening was performed using standard culture and susceptibility methods, with pulsed-field gel electrophoresis to determine relationships between VRE isolates. Pulsed-field gel electrophoresis analysis confirmed a single outbreak strain that was isolated from a video game found on one affected ward. Multivariate analysis identified cephalosporin use as the major risk factor for VRE colonization. CONCLUSIONS: In the present study outbreak, VRE colonization was significantly associated with cephalosporin use. Because shared recreational items and environmental surfaces may be colonized by VRE, they warrant particular attention in housekeeping protocols, in pediatric institutions

Objectives

Results

Conclusion