Prevalence of Various Genotypes of Vancomycin Resistant Enterococci in Neonatal Intensive Care

Abstract

After they were first identified in the mid-1980s, vancomycin-resistant enterococci (VRE) spread rapidly and became a major problem in many institutions both in Europe and the United States. Since VRE have intrinsic resistance to most of the commonly used antibiotics and the ability to acquire resistance to most of the current available antibiotics, either by mutation or by receipt of foreign genetic material, they have a selective advantage over other microorganisms in the intestinal flora and pose a major therapeutic challenge. The possibility of transfer of vancomycin resistance genes to other gram-positive organisms raises significant concerns about the emergence of vancomycin-resistant Staphylococcus aureus. Multiple drug–resistant organisms such as vancomycin –resistant enterococci (VRE),cause serious infections especially among high –risk patients in NICU, we started active surveillance cultures to determine their efficacy in detecting and controlling the speed of VRE among high risk infants active surveillance cultures other infection control measures, and mandatory in service education is the module for preventing multiple drug resistance organisms transmission which were performed on NICU on admission and then weekly during their stay, molecular DNA extraction from rectal swab specimen of VRE isolates then amplification and genotyping by PCR using 3 primers Van A, Van b,VanC1. Results: active surveillance cultures identified forty nine patients with VRE colonization or infection among 500 admitted to the NICU. PCR was done on this 49 identified plus 16 detected from reculture after 1 week. Two genes clusters appeared 36 were identified biochemical as E.faecium and were shown to contain Van A. 10 were identified as E. gallinum and contained Van C.1 specimens contained both E. faecium and E.gallinurm and 2 specimens were shown to contain Van B and identified as E.faecium. 16 VER isolates were identified from patients examined after 1 week 9 of them was contained Van A and identified as E.faecium 5 was contained Van C1 and identified asE.gallinurm.2 was contained Van B. Conclusions: VRE is often passed from person to person by the contaminated hands of caregivers. VRE can get onto a caregiver's hands after they have contact with other people with VRE or after contact with contaminated surfaces. VRE can also be spread directly to people after they touch surfaces that are contaminated with VRE. VRE is not spread through the air by coughing or sneezing, Control transmission of multi colonel VRE stains can be achieved by active surveillance cultures together with complementation of other infection control measures. The risk of VRE infection can be reduced by minimizing the use of indwelling devices such as intravenous lines and urinary catheters. The risk is also reduced by eliminating inappropriate use of antibiotics control of transmission of multiple drug resistance colonel VER strains active surveillance cultures together with implementation of other infection control measures, were instrumental in controlling VER transmission in NICU.