Incidence Of Vancomycin-resistant Enterococci Research Articles

Epidemiology and outcomes associated with enterococcal blood stream infection among liver and kidney transplant recipients.

Bloodstream infections (BSIs) account for 18% of bacterial infections in the first year after solid organ transplantation (SOT). Enterococcus accounts for up to 20% of BSIs in this population, with vancomycin-resistant enterococcus (VRE) posing a particular risk. This is a retrospective, case-control study of adult liver and kidney transplant recipients between 01/01/2016 and 06/30/2021 that characterizes the epidemiology and outcomes of enterococcal BSIs in liver and kidney transplantations at a single institution. Subjects with an enterococcal BSI within the first 6 months post-transplant were compared to those with non-enterococcal BSIs in the same period. We identified 26 subjects with enterococcal BSIs and 28 controls with non-enterococcal BSIs (n=54; 10.3%). Cases were mostly liver transplant recipients (n=20; 77%) with a median MELD at transplant of 33 (range 14-43); controls included 14 KT recipients (50%). Groups differed significantly (all p<.05) by factors including perioperative transfusion requirements, need for reoperation, and number of interventions post-transplant. Cases had a median time of 25.5 days to infection and controls 100.5 days (p<.0001). There were no differences in 1-year mortality between the groups. Enterococcus faecium was the predominant species of Enterococcus (n=23; 88.5%), with a majority (91.3%) of the isolates being VRE. In our liver and kidney transplants, enterococcal BSIs occurred early among liver transplant recipients. The high incidence of VRE among E. faecium isolates in this population warrants further investigation into the optimal approach to empiric antimicrobials for bacteremia in the early post-transplant period.

Epidemiology and infection control of vancomycin-resistant enterococci at a German university hospital: A three-year retrospective cohort study.

Vancomycin-resistant enterococci (VRE) occur in hospitalized patients, causing both infection and colonization. In recent years, there has been an increase in VRE in German and other hospitals, raising the question of how to control this epidemic best. To better understand the specific epidemiology and to guide infection control, we conducted a retrospective cohort study analyzing all patients with VRE at Hannover Medical School, a tertiary university clinic in Germany that specializes in solid organ transplantation. Epidemiologic and clinical characteristics of patients with VRE from 2015-2017 were collected. Basic epidemiologic parameters, including VRE incidence and incidence density, were calculated. Independent risk factors for nosocomial VRE infection compared to colonization were assessed using a logistic regression model. There were 1,492 VRE cases corresponding to 822 individual patients. The incidence was 0.8 VRE cases per 100 cases. A total of 536 (35.9%) of the 1,492 VRE cases were acquired nosocomially. Of the 1,492 cases, 912 cases had VRE-positive samples (894 Enterococcus (E.) faecium and 18 E. faecalis) in our hospital laboratory and the remaining cases were known VRE carriers. The vanB-phenotype was observed in 369 of the 894 (41.3%) E. faecium isolates and in 6 of the 18 (33.3%) E. faecalis isolates. There was an increase over time in the vanB-phenotype proportion in E. faecium (2015: 63 of 171, 36.8%, 2016: 115 of 322, 35.7% and 2017: 191 of 401, 47.6%). A total of 107 cases had a VRE infection (7.2% of all VRE cases) according to the criteria of the German National Reference Center for Surveillance of Nosocomial Infections. The remaining cases were only colonized. Among other factors, leukocytopenia (<1,000/μL), the use of a central venous catheter and the visceral surgery medical specialty were independently associated with nosocomial VRE infection. VRE imposed a relevant and increasing infection control burden at our hospital. Nosocomial VRE infection was predominantly found in certain medical specialties, such as hematology and oncology and visceral surgery. Infection control efforts should focus on these highly affected patient groups/specialties.

An Economic Evaluation Estimating the Clinical and Economic Burden of Increased Vancomycin-Resistant Enterococcus faecium Infection Incidence in Japan.

While incidence rates of vancomycin-resistant Enterococcus faecium have remained comparatively low in Japan, there have been increasing reports of more vancomycin-resistant Enterococcus (VRE) outbreaks, requiring costly measures to contain. Increased incidence of VRE in Japan may lead to more frequent and harder to contain outbreaks with current control measures, causing a significant burden to the healthcare system in Japan. This study aimed to demonstrate the clinical and economic burden of vancomycin-resistant E. faecium infections to the Japanese healthcare system and the impact of increasing rates of vancomycin resistance. A de novo deterministic analytic model was developed to assess the health economic outcomes of treating hospital-acquired VRE infections; patients are treated according to a two-line treatment strategy, dependent on their resistance status. The model considers hospitalisation costs and the additional cost of infection control. Scenarios investigated the current burden of VRE infections and the additional burden of increased incidence of VRE. Outcomes were assessed over a 1-year and 10-year time horizon from a healthcare payer's perspective in a Japanese setting. Quality-adjusted life years (QALYs) were valued with a willingness-to-pay threshold of ¥5,000,000 ($38,023), and costs and benefits were discounted at a rate of 2%. Current VRE incidence levels in enterococcal infections in Japan equates to ¥130,209,933,636 ($996,204,669) in associated costs and a loss of 185,361 life years (LYs) and 165,934 QALYs over 10 years. A three-fold increase (1.83%) is associated with an additional ¥4,745,059,504 ($36,084,651) in total costs on top of the current cost burden as well as an additional loss of 683 LYs over a lifetime, corresponding to 616 QALYs lost. Despite low incidence rates, VRE infections already represent a substantial economic burden to the Japanese healthcare system. The substantial increase in costs associated with a higher incidence of VRE infections could result in a significant economic challenge for Japan.

Impact of Clostridioides difficile length of treatment on rates of recurrence in patients on concurrent antibiotics

Clostridioides difficile infection (CDI) is principally healthcare-associated with substantial impact on morbidity and mortality. Guidelines recommend CDI therapy for 10 days; however, it is often extended in practice when concurrent antibiotics are used. The impact of the extended duration of therapy remains unclear. To compare rates of CDI recurrence in patients receiving standard duration of therapy (SDT) compared to extended duration of therapy (EDT) for the treatment of hospital-acquired CDI (HA-CDI) while receiving concurrent antibiotics. A retrospective chart review was conducted between October 2017 and 2019. Adult HA - CDI patients who received a minimum 10 days of CDI therapy and were on concurrent antibiotics were stratified into SDT and EDT groups. Rates of CDI recurrence (at 90 and 180 days) and incidence of new onset vancomycin-resistant enterococcus (VRE) were compared. 223 patients met the inclusion criteria (SDT - 106, EDT - 117). CDI recurrence rates at 90 and 180 days were not statistically significant between SDT and EDT groups (22% vs 26%, p = 0.40 and 26% vs 31%, p = 0.47). Although the incidence of VRE within the extended group was higher, it was not statistically significant (6% vs 9%, p = 0.29). No significant difference in rates of recurrence or new onset VRE were observed between SDT and EDT in HA-CDI patients.

213. Prophylactic oral vancomycin for Clostridioides difficile in allogeneic hematopoietic stem cell transplant recipients

Abstract Background Allogeneic hematopoietic stem cell transplant (alloHSCT) recipients are at substantial risk for Clostridioides difficile infection (CDI) due to prolonged hospitalization and alteration of the intestinal mucosa and gut microbiota from conditioning regimens, antimicrobials, and immunosuppressants. CDI in alloHSCT recipients has also been associated with higher rates of acute graft versus host disease (aGVHD). Review of the literature revealed that three institutions have published studies demonstrating oral vancomycin prophylaxis prevents CDI. However, more studies are needed to evaluate the impact of prophylaxis on CDI incidence, resistant infections, and other transplant-related outcomes. Methods We conducted a retrospective review to compare the effectiveness of prophylactic oral vancomycin versus no prophylaxis in 40 alloHSCT recipients in the prevention of CDI at our institution. The prophylactic intervention was initiated June 2020, and 20 patients have undergone alloHSCT as of April 2022. Patients received twice daily oral vancomycin starting the day of admission for transplant until discharge. The prophylaxis group was compared to a control group of 20 consecutive alloHSCT recipients prior to initiation of the intervention. The primary outcome was the incidence of CDI. Secondary outcomes included incidence of vancomycin resistant enterococcus (VRE) infection and incidence of aGVHD. Results During admission for transplant and at +100 days post-transplant, 5/20 (25%) of patients in the control group developed CDI compared to 0/20 (0%) in the prophylaxis group (p=0.0471). Prophylaxis was not associated with higher rates of VRE infection through day +100 post-transplant (2/20, 10% vs 0/20, 0%, p=0.487). Use of oral vancomycin was not associated with increased incidence of aGVHD, which occurred in 10/20 (50%) of patients in the control group versus (7/20) 35% in the prophylaxis group (p=0.523). Conclusion Prophylaxis with oral vancomycin was associated with a significant reduction in CDI. Use of prophylaxis was not associated with an increased risk for VRE infection and there was no change in incidence of aGVHD. Our review supports the use of prophylaxis, and we will continue to monitor for resistant infections and evaluate the impact on survival. Disclosures Alfred Luk, MD, Karius: Grant/Research Support.

2107. Epidemiology and Outcomes Associated with Enterococcal Blood Stream Infection among Abdominal Solid Organ Transplant Recipients

Abstract Background Bloodstream infections (BSIs) account for 18% of bacterial infections in the first year after solid organ transplantation (SOT). Enterococcus is an important cause of nosocomial BSI, accounting for up to 20% of BSIs in this population, with Vancomycin-resistant enterococcus (VRE) posing a particular risk. This study aims to characterize the epidemiology and outcomes of enterococcal BSIs in abdominal SOTs. Methods A retrospective, single-center, case-control study of adult abdominal organ transplant (kidney transplant (KT), liver transplant (LT), simultaneous liver-kidney transplant (SLK), pancreas transplant, or simultaneous pancreas-kidney transplant) recipients between 01/01/2016 - 07/30/2021 was conducted at Beth Israel Deaconess Medical Center. Subjects were identified and reviewed using the Organ Transplant Tracking Record, their online medical record, and Vigilanz. Subjects with an enterococcal BSI within the first 6 months post-transplant were compared to those with non-enterococcal BSIs in the same period. Results We identified 26 subjects with enterococcal BSIs and 28 controls with non-enterococcal BSIs (n = 54; 10.2%). Cases were mostly LT recipients (n = 20; 77%) with a median MELD at transplant of 33 (range 14 - 43). Controls included 8 LT recipients (29%), 14 KT recipients (50%), and 6 SLK recipients (21.4%). Groups differed significantly (all p&amp;lt; 0.05) by factors including perioperative transfusion requirements, need for reoperation, and number of interventions post-transplant. Most cases (n = 16; 62%) and 11 controls (39%) had received antibiotics within the month prior to transplant. Cases had a median time of 25.5 days to infection and controls 100.5 days (p &amp;lt; 0.0001) (Figure 1). There were no differences in 1-year mortality (Figure 2) between the groups. E. faecium was the predominant species of Enterococcus (n = 23; 88.5%), with a majority (91.3%) of the isolates being VRE. The VRE rate was 80.8% among cases, 38.9% among all BSIs, and 4.0% among all transplants. Table 1:Demographic, Surgical, Hospitalization, and Antimicrobial Data. Baseline demographic and clinical characteristics of enterococcal BSI cases and non-enterococcal BSI controls are compared, along with transplant characteristics, transfusion requirements, surgical risk factors, hospitalization data, outcomes, and antibiotic exposures. Microbiological and resistance data are also presented. Enterococcal BSIs had lower odds of being a kidney transplant and having CKD or CKD on RRT; they had higher odds of being a liver transplant and having prior immunosuppression, steroid induction alone, reoperations, and macrolide exposure. Enterococcal BSIs had lower KDPIs, higher transfusion requirements, lower cold ischemia times, more procedures, and a shorter time to BSI (Chi-square and Fischer exact tests for categorical variables; Mann-Whitney tests for continuous variables). **Liver and simultaneous liver-kidney transplants; ***Kidney and simultaneous liver-kidney transplants; ****Reoperation within two weeks of primary closure; *****Biopsy proven acute antibody or cellular rejection within 6 months of transplant; ******ERCP stenting compared to IR stenting, among those with biliary complication. BSI – bloodstream infection; CKD – chronic kidney disease; HIV – human immunodeficiency virus; MELD – model of end stage liver disease; KDPI – kidney donor profile index; CMV – cytomegalovirus; pRBC – packed red blood cells; ERCP – endoscopic retrograde cholangiopancreatography; RRT – renal replacement therapy. Figure 1:Time to Bloodstream InfectionProbability of BSI-free survival illustrated, with enterococcal BSIs occurring significantly earlier than non-enterococcal BSIs post-transplantation (Kaplan-Meier survival analysis). BSI – bloodstream infection.Figure 2:MortalityProbability of survival, without significant difference between enterococcal and non-enterococcal BSIs. Data censored at one year of follow-up. BSI – bloodstream infection. Conclusion In our abdominal organ SOTs, enterococcal BSIs occurred early among LT recipients. The high incidence of VRE among E. faecium isolates in this population warrants further investigation into the optimal approach to empiric antimicrobials for bacteremia in the early post-transplant period. Disclosures Carolyn D. Alonso, MD, Cidara Therapeutics: Advisor/Consultant|Merck: Advisor/Consultant.

The associated impact of standardized admission screening on vancomycin-resistant Enterococci bloodstream infections.

To determine whether discontinuing active screening for vancomycin-resistant Enterococcus (VRE) in Alberta, Canada, acute-care facilities had an associated impact on the rate of rise of hospital-acquired (HA) VRE bloodstream infection (VRE-BSI). Acute-care facilities in Alberta, Canada. All patients who were admitted to Alberta Health Services or Covenant Health acute-care facilities between January 1, 2013, and March 31, 2020, and who met the definition for hospital-acquired VRE-BSI were included in the analyses. An intervention time-series Poisson regression was used to determine the slope change in VRE incidence between the pre- and postintervention (screening) periods. The patient population was separated into 3 cohorts: group 1 (low risk, VRE screening stopped), group 2 (high risk, VRE screening stopped), and group 3 (high risk, VRE screening continued). For all groups, a level- and slope-change model was used. We did not find a statistically significant difference in the slope change or rate of rise in VRE-BSI before and after the intervention, with incidence rate ratio (IRRs) of 1.015 (95% confidence interval [CI], 0.982-1.049), 1.025 (95% CI, 0.967-1.086), and 0.989 (95% CI, 0.924-1.059) for groups 1, 2 and 3, respectively. In Alberta, the rate of HA VRE-BSI has remained consistent, and our findings indicate that there has been no increase in the rate of rise of HA VRE-BSI in sites or units that discontinued screening for VRE, regardless of patient risk group.

Real-world experience of how chlorhexidine bathing affects the acquisition and incidence of vancomycin-resistant enterococci (VRE) in a medical intensive care unit with VRE endemicity: a prospective interrupted time-series study

BackgroundCritically ill patients in intensive care units (ICUs) often acquire opportunistic infections or are colonized by vancomycin-resistant enterococci (VRE), which limits therapeutic options and results in high case-fatality rates. In clinical practice, the beneficial effects of universal chlorhexidine gluconate (CHG) bathing on the control of VRE remain unclear. This study aimed to investigate whether 2% CHG daily bathing reduced the acquisition of VRE in the setting of a medical ICU (MICU) with VRE endemicity.MethodsThis quasi-experimental intervention study was conducted in a 23-bed MICU of a tertiary care hospital in Korea from September 2016 to December 2017. In a prospective, interrupted time-series analysis (ITS) with a 6-month CHG bathing intervention, we compared the acquisition and incidence of VRE and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) between the pre-intervention and intervention periods. The primary and secondary outcomes were a change in the acquisition of VRE and incidence of VRE, MRSA, or CRAB between the two periods, respectively.ResultsAll the adult patients admitted to the MICU were enrolled in the pre-intervention (n = 259) and intervention (n = 242). The overall CHG daily bathing compliance rate was 72.5%. In the ITS, there was a significant intervention effect with a 58% decrease in VRE acquisition (95% CI 7.1–82.1%, p = 0.038) following the intervention. However, there was no significant intervention effects on the incidence trend of VRE, MRSA, and CRAB determined by clinical culture between the pre-intervention and intervention periods.ConclusionIn this real-world study, we concluded that daily bathing with CHG may be an effective measure to reduce VRE cross-transmission among patients in MICU with a high VRE endemicity.

Seasonal Patterns in Incidence and Antimicrobial Resistance of Common Bacterial Pathogens in Nursing Home Patients and Their Rooms.

Background: Colonization is the main precursor to infection, which may lead to adverse clinical outcomes among older adults in nursing homes (NHs). Understanding seasonal changes in the local burden of common bacterial pathogens is key to implementing appropriate and cost-effective infection prevention measures in this resource-constrained healthcare environment. It is thus surprising that seasonal trends in patient and environmental colonization with major bacterial pathogens are presently unknown in the expanding NH setting.Methods: We examined the seasonal incidence of four major pathogens among 640 nursing home patients and high-touch surfaces within their rooms over 2 years. In cases where a significant number of antimicrobial-resistant strains was found, incidence in antimicrobial-susceptible and antimicrobial-resistant isolates was compared, along with antibiotic use trends.Results: We observed spring peaks in the incidence of vancomycin-resistant enterococci (1.70 peak to trough ratio for both patient and environmental isolates) and methicillin-resistant Staphylococcus aureus (1.95 peak to trough ratio for patient isolates, 1.50 for environmental isolates). We also observed summer peaks in Klebsiella pneumoniae (1.83 and 1.82 peak to trough ratio for patient and environmental isolates, respectively), and ciprofloxacin-resistant Escherichia coli. Susceptible S. aureus and E. coli did not follow seasonal patterns.Conclusions: A meaningful seasonal pattern may be present in the NH setting for several significant pathogens, and especially antimicrobial-resistant ones. Whether such patterns are consistent across geographic areas and over longer periods of time should be a key focus of investigation, in order to better inform timing of surveillance and infection prevention efforts in this setting.

Vancomycin resistant Enterococci and its associated factors among HIV infected patients on anti-retroviral therapy in Ethiopia.

The emergence of vancomycin resistant Enterococci (VRE) has alarmed the global community due to its tendency for colonization of the gastrointestinal tract. Human Immunodeficiency Virus (HIV) patients are colonized by vancomycin resistant Enterococci than other groups. The aim of this study was to determine the incidence of vancomycin resistant Enterococci and its associated factors among HIV infected patients on Anti-Retroviral Therapy (ART). Institution based cross sectional study was conducted among HIV infected patients on ART at from June 1 to August 30, 2020. Socio-demographic and clinical data were collected by pre-tested structured questionnaire. Stool sample was collected and processed by standard microbiological techniques. Kirby Bauer Disc diffusion method was used to perform antimicrobial susceptibility testing. Data were entered by Epi data version 4.6.0.2 and analyzed by SPSS version 25. Bivariable and multivariable logistic regression model was used to analyze the association between dependent and independent variables. P-values in the multivariable analysis, adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to determine the strength of association. P-value ≤0.05 was considered as significant. Enterococci spp was isolated on 123/200 (61.50%) patients. Among these isolates, the incidence of vancomycin resistant Enterococci was 11.4% [95% CI: (6.0-17.0)]. Antimicrobial susceptibility patterns against Enterococci showed highest rate of resistance to ampicillin (69.9%). Multidrug resistances were observed in 49.59% of Enterococci isolates. Study participants who had prior antibioticexposurer more than two weeks [AOR = 7.35; 95% CI: (1.2144.64)] and hospitalization for the last six months [AOR = 5.68; 95% CI: (1.09 29.74)] were significantly associated with vancomycin resistant Enterococci. In our study high incidence of vancomycin resistant Enterococci was found. Previous exposure to antibiotics for more than two weeks and hospitalization for more than six months were significantly associated with vancomycin resistant Enterococci. The isolated Enterococci had variable degrees of resistance to commonly prescribed antibiotics. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics and implementing infection prevention protocols may reduce colonization by VRE.

Evaluating Clostridioides difficile infection (CDI) treatment duration in hematology/oncology patients receiving concurrent non-CDI antibiotics.

To determine the impact of Clostridioides difficile infection (CDI) treatment duration on CDI recurrence in hematology/oncology patients receiving concurrent non-CDI antibiotics. This multi-site, retrospective study examined hematology/oncology patients age ≥18 years hospitalized with active CDI who received ≥1 dose of concurrent non-CDI antibiotics between September 2013 and June 2019. All patients were classified by two definitions for statistical analysis: standard (10-14 days) versus prolonged (>14 days) duration of CDI treatment and non-extended (≤24 hours after stopping non-CDI antibiotics) versus extended (>24 hours after stopping non-CDI antibiotics) CDI treatment. Primary outcome was CDI recurrence within 180 days of completing CDI treatment. Secondary outcomes included hospital length of stay (LOS) as well as mortality and incidence of vancomycin-resistant enterococcus (VRE) infections at 180 days. Of the 198 patients included, 112 were classified as prolonged versus 86 standard duration and 138 were classified as extended versus 60 non-extended duration. After accounting for demographic differences, no difference existed in the primary outcome of CDI recurrence in either prolonged versus standard or extended versus non-extended analysis (all p > 0.05). Patients who received prolonged versus standard CDI treatment had longer LOS (p < 0.0001) while no difference existed in extended versus non-extended (p > 0.05). No difference in mortality existed in prolonged versus standard (p > 0.05) while those who received extended versus non-extended CDI treatment had significantly lower mortality (p = 0.0008). Neither prolonging CDI treatment beyond standard duration nor extending duration beyond end of non-CDI antibiotics was associated with decreased CDI recurrence rate.

Appropriate Vancomycin Use and Incidence of Vancomycin-Resistant Enterococci in Liver Transplant Recipients

Liver transplant recipients (LTRs) are at risk for vancomycin-resistant Enterococcus (VRE) infections which can lead to significant morbidity or mortality. Antibiotic exposure, including vancomycin, is associated with greater risk of VRE infection. This study aimed to assess the appropriateness of vancomycin use and rates of VRE infection in this population. We performed a retrospective cohort study of 327 patients who underwent liver transplantation at our center from January 1, 2012 to June 30, 2017. Sixty (18.3%) LTRs had at least one VRE-positive culture between six-months pre-transplant and six-months post-transplant. LTRs with VRE had greater vancomycin exposure as compared to VRE-negative LTRs (p &lt; 0.05) and were more likely to receive prolonged vancomycin courses (&gt; 72 hours, p &lt; 0.05). Overall appropriateness of vancomycin use &gt; 72 hours among VRE-positive LTRs was only 26.8%. Inappropriate vancomycin use most commonly occurred in patients with presumed sepsis without an identifiable source or pneumonia with negative respiratory cultures. Our findings illustrate an opportunity to improve antibiotic stewardship and reduce vancomycin use in the transplant population

PREVALENCE OF VANCOMYCIN RESISTANT ENTEROCOCCI AMONG PATIENTS WITH NOSOCOMIAL INFECTIONS IN INTENSIVE CARE UNIT

Background: Enterococcus has increasingly become a major nosocomial pathogen worldwide. It has been well documented that intensive care units (ICUs) are the major reservoirs of vancomycin resistant enterococci (VRE) in the health care setting. It is a matter of concern due to its ability to transfer vancomycin resistant gene to other organisms. Objective: Evaluation of the incidence of VRE as a cause of nosocomial infection in ICU patients, to analyze their antibiotic resistance profile, and to search for resistance genes of VanA and VanB in VRE isolates from these patients. Patients and methods: Four hundred ICU patients with nosocomial infections were studied during the period between Jan, 2016 and Feb, 2017 at Misr University for Science and Technology Hospital. Results: Enterococci were isolated from 12% of patients, of whom 66.7% E.faecalis and 33.3% E. facium. 41.7% isolates exhibited resistance to vancomycin. Among these isolates, 60% of strains were E. faecium, while 40% were E. faecalis. Polymerase chain reaction (PCR) detection of Van A and Van B resistance genes showed that Van A gene was detected in 85% of the VRE isolates, while Van B gene not found in any of the VRE isolates. Conclusion: VRE and Van A gene were important as a cause of nosocomial infections in ICU patients. All VRE were multidrug resistant and few treatment options were available. Effective infection control measures against VRE are required.

PREVALENCE OF VANCOMYCIN RESISTANT ENTEROCOCCI AMONG PATIENTS WITH NOSOCOMIAL INFECTIONS IN INTENSIVE CARE UNIT

Background: Enterococcus has increasingly become a major nosocomial pathogen worldwide. It has been well documented that intensive care units (ICUs) are the major reservoirs of vancomycin resistant enterococci (VRE) in the health care setting. It is a matter of concern due to its ability to transfer vancomycin resistant gene to other organisms. Objective: Evaluation of the incidence of VRE as a cause of nosocomial infection in ICU patients, to analyze their antibiotic resistance profile, and to search for resistance genes of VanA and VanB in VRE isolates from these patients. Patients and methods: Four hundred ICU patients with nosocomial infections were studied during the period between Jan, 2016 and Feb, 2017 at Misr University for Science and Technology Hospital. Results: Enterococci were isolated from 12% of patients, of whom 66.7% E.faecalis and 33.3% E. facium. 41.7% isolates exhibited resistance to vancomycin. Among these isolates, 60% of strains were E. faecium, while 40% were E. faecalis. Polymerase chain reaction (PCR) detection of Van A and Van B resistance genes showed that Van A gene was detected in 85% of the VRE isolates, while Van B gene not found in any of the VRE isolates. Conclusion: VRE and Van A gene were important as a cause of nosocomial infections in ICU patients. All VRE were multidrug resistant and few treatment options were available. Effective infection control measures against VRE are required.

VRE Screening and Isolation: One Size Does Not Fit All

Background: The need for screening and isolation for patients colonized with vancomycin-resistant Enterococcus (VRE) remains controversial. In this study, we examined the effects of discontinuation and reinstatement of these practices on VRE infection and colonization incidence within a multisite, tertiary-care hospital center, including its effects on specific at-risk groups. Methods: We retrospective analyzed VRE clinical isolate, infection, and bacteremia incidence rates at our hospital (1) prior to discontinuation of universal screening and isolation (January 2010–June 2012), (2) during discontinuation (July 2012–April 2017), and (3) after reinstatement of screening and isolation in high-risk wards (intensive care and multiple-organ transplant units, June 2017–April 2019). Monthly incidence rates were calculated for each of 3 sites at our tertiary-care hospital: site A, which includes the transplant program, site B, an adult cancer hospital, and site C, which includes orthopedic and neurology programs. To understand the differential effect of screening and isolation on various risk groups, incidence rates were also calculated for individual programs within our hospital, including medicine, surgery, intensive care, oncology, and transplant programs. Results: During the period of study, 3,167 cases of VRE isolates were identified. Patient colonizations of VRE across the institution increased throughout the study period, with the monthly number of newly colonized patients increasing from 10.4 in the first period of study to 20.6 in the last period. The overall VRE clinical isolate, infection, and bacteremia incidence rates did not increase following the cessation of VRE screening and isolation precautions; however, a significant increase was seen among the patients at site B (Fig. 1, infection rates). Furthermore, there was a significant decrease in VRE clinical isolate, infection, and bacteremia incidence following the reinstatement of screening in the ICU and transplant programs at site A, but no effect was seen in the other programs (Fig. 2, infection rates). Conclusions: The risk associated with discontinuing VRE screening and isolation measures appears depend on the subgroup of patients within a hospital environment. Furthermore, risk-based or unit-based VRE screening and isolation appears to be effective at controlling VRE incidence, even after measures had previously been discontinued. Additional study of other inpatient settings is warranted to determine the effects of screening and isolation for VRE on other patient subgroups.Funding: NoneDisclosures: Susy Hota reports contract research for Finch Therapeutics.

574. Reporting of Vancomycin-Resistant Enterococcus Bacteremia among National Healthcare Safety Network Acute Care Hospitals

BackgroundThe National Healthcare Safety Network’s (NHSN’s) Multidrug-resistant Organism/Clostridioides difficile (MDRO/CDI) Module serves as a surveillance platform for tracking antibiotic-resistant laboratory-identified (LabID) organisms. LabID event surveillance, which does not require submission of clinical data to NHSN, provides proxy measures for MDRO burden. While surveillance of some organisms is federally mandated, these requirements do not extend to vancomycin-resistant Enterococcus (VRE). We sought to describe the extent of acute care hospital (ACH) participation in NHSN VRE surveillance and identify facility-level factors associated with VRE bacteremia. These could explain differences in VRE incidence and be used in preparation for a national risk-adjusted benchmark.MethodsACHs that reported at least one month of facility-wide inpatient (FacWideIN) VRE bacteremia LabID Event data to NHSN in 2017 were included in the analysis. LabID events were categorized as healthcare facility-onset (HO), defined as a laboratory result for a specimen collected ≥4 days after admission, or community-onset (CO), defined as a specimen collected < 4 days after admission. Monthly patient day and admission denominators were used to calculate FacWideIN HO incidence and CO prevalence rates. Univariate analyses were performed on facility-level factors from NHSN’s annual hospital survey to assess their relationship with HO VRE bacteremia.ResultsA total of 544 HO VRE bacteremia events were reported by 498 hospitals in 37 states. About 67% of reporting hospitals were located in California. The national rate of HO VRE bacteremia was 0.27 per 10,000 patient-days and the CO VRE bacteremia rate was 0.58 per 10,000 admissions. Major medical school affiliation, hospital type, larger number of beds and ICU beds, longer average length of stay and the presence of an oncology unit were significantly associated with HO VRE bacteremia (Table 1).ConclusionBased on the VRE data reported to NHSN, certain facility-level factors may contribute to a higher incidence of HO VRE bacteremia. Future analyses can allow us to determine whether these factors are independently associated with VRE. Risk-adjusted surveillance data can help guide facilities and states to compare their burden of VRE to a national benchmark. Disclosures All authors: No reported disclosures.

Effectiveness of Oral Vancomycin for Prevention of Healthcare Facility-Onset Clostridioides difficile Infection in Targeted Patients During Systemic Antibiotic Exposure.

Limited retrospective data suggest prophylactic oral vancomycin may prevent Clostridioides difficile infection (CDI). We sought to evaluate the effectiveness of oral vancomycin for the prevention of healthcare facility-onset CDI (HCFO-CDI) in targeted patients. We conducted a randomized, prospective, open-label study at Novant Health Forsyth Medical Center in Winston-Salem, North Carolina, between October 2018 and April 2019. Included patients were randomized 1:1 to either oral vancomycin (dosed at 125 mg once daily while receiving systemic antibiotics and continued for 5 days postcompletion of systemic antibiotics [OVP]) or no prophylaxis. The primary endpoint was incidence of HCFO-CDI. Secondary endpoints included incidence of community-onset healthcare facility-associated CDI (CO-HCFA-CDI), incidence of vancomycin-resistant Enterococci (VRE) colonization after receiving OVP, adverse effects, and cost of OVP. A total of 100 patients were evaluated, 50 patients in each arm. Baseline and hospitalization characteristics were similar, except antibiotic exposure. No events of HCFO-CDI were noted in the OVP group compared with 6 (12%) in the no-prophylaxis group (P = .03). CO-HCFA-CDI was identified in 2 patients who were previously diagnosed with HCFO-CDI. No patients developed new VRE colonization, with only 1 patient reporting mild gastrointestinal side effects to OVP. A total of 600 doses of OVP were given during the study, with each patient receiving an average of 12 doses. Total acquisition cost of OVP was $1302, $26.04 per patient. OVP appears to protect against HCFO-CDI during in-patient stay in targeted patients during systemic antibiotic exposure. Further prospective investigation is warranted.

In Vitro Synergistic Effect of Vancomycin Combined with Daptomycin Against Vancomycin-Resistant Enterococci.

New antimicrobial agents are being designed to treat infections of multidrug-resistant pathogens and have been introduced in the past few years, but there has been a worldwide increase in the incidence of vancomycin-resistant enterococci (VRE) infections, and treatment options are still limited. In this study, it was aimed to investigate the in vitro activity of vancomycin combined with daptomycin against 30 VRE strains. The minimum inhibitory concentration (MIC) values of antibiotics were determined using broth microdilution assay as described by the Clinical and Laboratory Standards Institute (CLSI). The activities of antibiotics in combination were assessed using a broth microcheckerboard method. In addition, 4 of the 30 strains were randomly selected to determine the time-kill curves at 1 × MIC concentrations and 2 of 4 strains at ½ × MIC concentrations. Viable counts were determined at 0-, 4-, 8-, 12-, 24-, 48-, and 72-hr intervals. This was accomplished by subculturing 0.1 mL from repetitive serial dilutions in Eppendorf tubes, followed by subculturing 0.1 mL from tubes onto Tryptic Soy Agar plates. All plates were incubated at 35°C for 24 hr. The synergistic effect was found 100% using the broth microcheckerboard method, and in strains tested using the time-kill method at both 1 × MIC and ½ × MIC concentrations. The results of this study suggest that this combination could be effective in the treatment of the VRE-associated infection.

280. The Impact of a Revised Neutropenic Fever Guideline on Vancomycin-Resistant Enterococcus Rates in Pediatric Oncology Patients

BackgroundData on the impact of empiric febrile neutropenia (FN) guidelines on resistant bacteria in pediatric oncology patients are limited. We implemented a risk-stratified guideline for empiric FN antibiotics, limiting vancomycin use to high-risk patients for 48 hours if cultures were negative. Our aim was to assess the impact of this intervention on rates of vancomycin-resistant Enterococcus (VRE) and vancomycin use.MethodsWe conducted a retrospective, quasi-experimental study of oncology patients ≤ 18 years with FN admitted from 2010 to 2014. Microbiologic data and inpatient antibiotic use were obtained by chart review. Risk strata incorporated diagnosis, chemotherapy phase, Down syndrome, septic shock, and typhlitis. The primary outcome was VRE incidence; all VRE isolates were included but active surveillance was only performed in intensive care units (ICUs) in both periods. We compared VRE incidence and antibiotic days of therapy (DOT) before and after the intervention using interrupted time-series analysis with segmented Poisson regression with auto-correlation.ResultsWe identified 183 patients with 765 admissions and 382 FN episodes pre-intervention, and 185 patients with 830 admissions and 385 FN episodes post-intervention. The proportion of high-risk patients was 51% pre vs. 45% post (P = 0.06). Median length of stay for FN admissions was 7 days (IQR: 4–22) preintervention and 5 days (IQR: 3–15) postintervention (P ≤ 0.01). Median duration of empiric vancomycin decreased from 5 days (IQR: 3–9) pre- to 3 days (IQR: 3–4) postintervention (P ≤ 0.01). Empiric vancomycin DOT/1,000 FN days decreased from 287 preintervention to 199 postintervention (P ≤ 0.01). Incidence of VRE/1,000 patient-days decreased significantly from 1.71 preintervention to 0.45 postintervention (IRR=0.26, 95% CI 0.09–0.80; P = 0.02). The proportion of VRE isolates representing colonization did not differ significantly pre- and postintervention (50% vs. 67%).ConclusionImplementation of an FN guideline limiting vancomycin exposure was associated with decreased incidence of VRE among pediatric oncology patients. Antimicrobial stewardship interventions are feasible in immunocompromised patients and can impact antibiotic resistance. Disclosures All authors: No reported disclosures.

Effectiveness of ultraviolet disinfection in reducing hospital-acquired Clostridium difficile and vancomycin-resistant Enterococcus on a bone marrow transplant unit.

To determine the effectiveness of ultraviolet (UV) environmental disinfection system on rates of hospital-acquired vancomycin-resistant enterococcus (VRE) and Clostridium difficile. Using active surveillance and an interrupted time-series design, hospital-acquired acquisition of VRE and C. difficile on a bone marrow transplant (BMT) unit were examined before and after implementation of terminal disinfection with UV on all rooms regardless of isolation status of patients. The main outcomes were hospital-based acquisition measured through (1) active surveillance: admission, weekly, and discharge screening for VRE and toxigenic C. difficile (TCD) and (2) clinical surveillance: incidence of VRE and CDI on the unit. Bone marrow transplant unit at a tertiary-care cancer center.ParticipantsStem cell transplant (SCT) recipients.InterventionTerminal disinfection of all rooms with UV regardless of isolation status of patients. During the 20-month study period, 579 patients had 704 admissions to the BMT unit, and 2,160 surveillance tests were performed. No change in level or trend in the incidence of VRE (trend incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.81-1.14; level IRR, 1.34; 95% CI, 0.37-1.18) or C. difficile (trend IRR, 1.08; 95% CI, 0.89-1.31; level IRR, 0.51; 95% CI, 0.13-2.11) was observed after the intervention. Utilization of UV disinfection to supplement routine terminal cleaning of rooms was not effective in reducing hospital-acquired VRE and C. difficile among SCT recipients.