Rate Of Vancomycin-resistant Enterococcus Colonization Research Articles

Rectal vancomycin-resistant enterococcus colonization before admission to neonatal intensive care unit

Aim: Vancomycin resistant enterococci (VRE) colonization is an important issue for healthcare recipients. The aim of this study is to determine the prevalence of VRE colonization in patients at the admission to the neonatal intensive care unit (NICU).
 Materials and Methods: In this retrospective study the medical records of patients who hospitalized to NICU between January 2010 to December 2019 were analyzed. At the admission, patients whose rectal cultures were detected as VRE colonization were evaluated for demographic characteristics for the risk factors of colonization. 
 Results: One thousand three hundred twenty-three patients were admitted to our NICU from different centers were enrolled. Rectal VRE colonization was observed in 60 of 1323 (4.54%) patients. Sixty-five percent (39/60) of patients with rectal VRE colonization had no previous hospitalization history. Among these 60 patients 28 of them were admitted to our NICU in the first week of their life. 
 Conclusion: Although hospitalization still remains an important risk factor for VRE colonization, we found that there is also a high rate of VRE colonization in newborns without a history of hospitalization or frequent outpatient admissions to pediatrics departments. That is a worrisome status that suggests that colonization may be developed in low risk areas of the hospital such as delivery room, operating room or recovery room.

Decrease in Vancomycin-Resistant Enterococcus Colonization After Extensive Renovation of a Unit Dedicated to the Treatment of Hematologic Malignancies and Hematopoietic Stem-Cell Transplantation.

OBJECTIVE While a direct relation between hospital construction and concomitant infection rates has been clearly established, few data are available regarding the environmental decontamination effects of renovation in which surfaces are replaced and regarding subsequent infection incidence. DESIGN Retrospective clinical study with vancomycin-resistant Enterococcus (VRE) molecular strain typing and environmental cultures. SETTING A regional referral center for acute leukemia and hematopoietic stem-cell transplantation. PATIENTS Overall, 536 consecutive hospital admissions for newly diagnosed acute leukemia or a first autologous or allogeneic stem-cell transplantation were reviewed. INTERVENTION During 2009-2010, our unit underwent complete remodeling including replacement of all surfaces. We assessed the effects of this construction on the incidence of hospital-acquired VRE colonization before, during, and after the renovation. RESULTS We observed a sharp decrease in VRE colonization rates (hazard ratio, <0.23; 95% confidence interval, 0.18-0.44; P<.0001) during the first year after the renovation, with a return to near baseline rates thereafter. The known risk factors for VRE colonization appeared to be stable over the study interval. Environmental cultures outside of patient rooms revealed several contaminated areas that are commonly touched by unit personnel. Multilocus sequence typing of VRE isolates that were cryopreserved over the study interval showed that dominant strains prior to construction disappeared and were replaced by other strains after the renovation. CONCLUSIONS Unit reconstruction interrupted endemic transmission of VRE, which resumed with novel strains upon reopening. Contamination of environmental surfaces and shared equipment may play an important role in endemic transmission of VRE. Infect Control Hosp Epidemiol 2017;38:1055-1061.

Room contamination, patient colonization pressure, and the risk of vancomycin-resistant Enterococcus colonization on a unit dedicated to the treatment of hematologic malignancies and hematopoietic stem cell transplantation

Contaminated surfaces and colonization pressure are risk factors for vancomycin-resistant Enterococcus (VRE) colonization in intensive care units (ICUs). Whether these apply to modern units dedicated to the care of hematologic malignancies and hematopoietic stem cell transplant (HSCT) procedures is unknown. We reviewed the records of 780 consecutive admissions for acute leukemia, autologous HSCT, or allogeneic HSCT in which the patient was at risk for hospital-acquired VRE and underwent weekly surveillance. We also obtained staff and room cultures, observed staff behavior, and performed VRE molecular strain typing on selected isolates. The overall rate of VRE colonization was 11.4 cases/1,000 patient days. Cultures of room surfaces revealed VRE isolates in 10% of terminally cleaned rooms. A prior VRE-colonized room occupant did not increase risk, and paired isolates from 20 patients and prior occupants were indistinguishable on molecular typing in only 1 pair. VRE colonization pressure was significantly associated with acquisition. Cultures of unit personnel and shared equipment were negative except for weighing scales. Observation of unit clinical personnel showed high compliance for hand sanitation and but less so for gowns. Conversely, ancillary staff showed poor compliance. Transmission of VRE from room surfaces seems to be an infrequent event. Encouraging adherence to surveillance, disinfection, and contact isolation protocols may decrease VRE colonization rates.

Screening for Intestinal Colonization with Vancomycin Resistant Enterococci and Associated Risk Factors among Patients Admitted to an Adult Intensive Care Unit of a Large Teaching Hospital.

Gut colonization with Vancomycin Resistant Enterococci (VRE) increases the risk of acquiring infection during hospital stay. Patients admitted in the ICU's are the major reservoirs for VRE colonization due to higher antibiotic pressure. To determine the rate of VRE colonization among patients admitted in the Medical Intensive Care Unit (MICU) and to assess the various risk factors which are associated with VRE colonization. This was a prospective study carried out over a period of 18 months from September 2013 to February 2015 in the Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Pondicherry, South India. After 48 hours of ICU admission rectal swabs were collected from a total of 302 patients, admitted in MICU. The samples were inoculated on to Bile Esculin Sodium Azide agar with 6mg/L of vancomycin. Vancomycin resistance was confirmed by determination of Minimum Inhibitory Concentration (MIC) by agar dilution method. Isolates were identified up to species level by standard biochemical tests. Vancomycin resistance genes such as van A, van B and van C, were detected by Polymerase Chain Reaction (PCR). Risk factors were assessed by multivariate logistic regression analysis. The rates of VRE colonization in patients admitted to MICU was 29%. Majority of the isolates were Enterococcus faecium (77.2 %) followed by Enterococcus faecalis (23.8%). All the VRE isolates were positive for van A gene. Increased duration of hospital stay, younger age, consumption of ceftriaxone and vancomycin were found to be significantly associated with VRE colonization in MICU. Among VRE colonized patients, six (4.5%) acquired VRE infection. The rates of VRE colonization in our ICU were similar to other hospitals worldwide. Educating health care workers on the importance of adherence to hand hygiene is essential to bring down VRE colonization rates.

IMPACT of Chlorhexidine Bathing on Hospital-Acquired Infections and Skin Tolerance Among STEM CELL Transplant Patients

Central-line associated bloodstream infection (CLABSI) and Vancomycin-Resistant Enterococcus (VRE) colonization is not uncommon among Stem Cell Transplant (SCT) patients by nature of their underlying disease, immunodeficiency, and prolonged neutropenia. Chlorhexidine Gluconate (CHG) bathing has been extensively researched in the intensive care and medical/surgical units, but there is minimal literature regarding the oncology population, specifically SCT patients. Results of a literature review suggest that daily bathing with CHG may prevent hospital-acquired bloodstream infections and VRE colonization among SCT patients. The purpose of this quality improvement initiative was to evaluate the operational efficacy of a pilot implementation of daily CHG bathing in SCT patients. The secondary goal was to evaluate patient compliance, and to monitor the frequency and severity of CHG skin reactions. Sixteen patients on a 12-bed pod SCT unit were instructed to bathe daily with CHG wash during their admission for a two-month period. The nurses and nursing assistants on the unit were educated on the use of the CHG solution. All patients without known sensitivity to CHG 4% solution were educated by an RN during admission class and given instructions regarding CHG bathing and possible skin reactions. Active surveillance testing for VRE was obtained within 48 hours of admission and repeated weekly through rectal swabs. The infection-control preventionist investigated all suspected hospital-acquired infections (HAIs). Although CLABSI and VRE colonization rates post-implementation of daily CHG bathing were statistically not significant, the VRE infection rate remained low at 0.12 per 1,000 patient days. Compliance rate with CHG bathing was 90% whereas incidence of skin reactions was 0.06%. Results from this pilot demonstration suggest that CHG may be an effective strategy in reducing VRE colonization and preventing CLABSI and other infections in SCT patients. CHG is a well-tolerated solution and patient compliance is high. As a result, daily CHG bathing has been implemented throughout the 48-bed SCT unit. Further controlled studies can be conducted in this population to demonstrate difference in VRE colonization between daily CHG compared to soap and water bathing. In addition, cost-effectiveness can be evaluated.

Frequency, Risk Factors, and Outcomes of Vancomycin-Resistant Enterococcus Colonization and Infection in Patients with Newly Diagnosed Acute Leukemia: Different Patterns in Patients with Acute Myelogenous and Acute Lymphoblastic Leukemia

OBJECTIVE To determine the frequency, risk factors, and outcomes for vancomycin-resistant Enterococcus (VRE) colonization and infection in patients with newly diagnosed acute leukemia. DESIGN Retrospective clinical study with VRE molecular strain typing. SETTING A regional referral center for acute leukemia. PATIENTS Two hundred fourteen consecutive patients with newly diagnosed acute leukemia between 2006 and 2012. METHODS All patients had a culture of first stool and weekly surveillance for VRE. Clinical data were abstracted from the Intermountain Healthcare electronic data warehouse. VRE molecular typing was performed utilizing the semi-automated DiversiLab System. RESULTS The rate of VRE colonization was directly proportional to length of stay and was higher in patients with acute lymphoblastic leukemia. Risk factors associated with colonization include administration of corticosteroids (P=0.004) and carbapenems (P=0.009). Neither a colonized prior room occupant nor an increased unit colonization pressure affected colonization risk. Colonized patients with acute myelogenous leukemia had an increased risk of VRE bloodstream infection (BSI, P=0.002). Other risk factors for VRE BSI include severe neutropenia (P=0.04) and diarrhea (P=0.008). Fifty-eight percent of BSI isolates were identical or related by molecular typing. Eighty-nine percent of bloodstream isolates were identical or related to stool isolates identified by surveillance cultures. VRE BSI was associated with increased costs (P=0.0003) and possibly mortality. CONCLUSIONS VRE colonization has important consequences for patients with acute myelogenous leukemia undergoing induction therapy. For febrile neutropenic patients with acute myelogenous leukemia, use of empirical antibiotic regimens that avoid carbapenems and include VRE coverage may be helpful in decreasing the risks associated with VRE BSI.

The Worth of Surveillance for Vancomycin-Resistant Enterococci in the Hematology-Oncology Unit

Background: Vancomycin-resistant enterococcus (VRE) has become a nosocomial pathogen of increasing importance. First identified in Europe in 1988, it has since been identified in multiple sites in the United States and Canada, as well as in Latin America. A 20-fold increase in the percentage of enterococci associated with nosocomial infections that were resistant to vancomycin, from 0.4% in 1989 to 7.9% in 1993, has been reported by the Centers for Disease Control and Prevention. VRE outbreak has been identified on February 2012 in hematology-oncology unit. It has since implemented some outbreak measures in order to control this outbreak, and as part of the control program during this outbreak of VRE infection in oncology-hematology unit of our tertiary care hospital, swab anal cultures have been performed weekly for inpatients as well as at the moment of their hospitalization.Objectives: To assess the incidence of colonization and infection by VRE of admitted patients in oncology-hematology unit and to evaluate the role of neutropenia and central line as well as their impact on blood stream infection (BSI) by VRE in previous colonized patients.Methods: All patients admitted to hematology-oncology unit in Instituto do Câncer do Estado de São Paulo São Paulo (ICESP) were undertaken to surveillance for VRE by Hospital Infection Control Committee from March 1, 2012 to May 31, 2014. It is important to highlight that ICESP has not promoted bone marrow transplantation. Neutropenia was defined as a neutrophil count ≤0.5 x 109/L. Feces (in patients with neutropenia) or rectal swab for those with a neutrophil count >0.5 x 109/L were collected for research VRE on admission and weekly for those that persist with negative results. Enterococci were isolated by standard microbiological methods. It was considered patients with colonized VRE when a bacterium is present, without any signs or symptoms of infection. BSI by VRE was defined in patients with positive blood culture for VRE.Results: A total of 1,666 patients had been screening for VRE colonization. One hundred sixty-one cases of VRE colonization were detected among them. The rate of VRE colonization during hospitalization was 9.7%. The incidence rate of VRE colonization was 9.4 cases per 1,000 inpatient-days. Twenty (12.4%) out of 161 VRE colonized patients developed BSI by VRE. The incidence of BSI by VRE was 1.2 cases per 1,000 inpatient-days. Eleven (55%) patients with BSI by VRE presented Acute Leukemia. A hundred percent of patients with BSI by VRE presented neutropenia and 14 (70%) out of 20 had central venous catheter inserted as well.Conclusions: We conclude that it is important to perform surveillance for VRE due to our incidence of patients colonized by VRE such as BSI by VRE. We believe these data may justify surveillance attendance and contact precautions. It was observed the importance of neutropenia to BSI by VRE in patients previously colonized. Thus, this fact could suggest that others studies are necessary in order to evaluate the role of antibiotic as linezolid for febrile neutropenia treatment in patients colonized by VRE. DisclosuresNo relevant conflicts of interest to declare.

Regional differences in vancomycin-resistant Enterococcus colonization rates in critically ill veterans

Screening for vancomycin-resistant Enterococcus (VRE) has not been universally implemented within the Department of Veterans Affairs (VA). A prospective study was conducted to identify the admission prevalence rate of VRE in patients admitted to the intensive care unit in 2 VA facilities. Significant regional differences were found between the 2 facilities. Further studies are needed to account for regional differences in VRE admission prevalence, to optimize infection control interventions.

Risk factors for vancomycin-resistant Enterococcus colonization in hematologic patients

Vancomycin-resistant Enterococci (VRE) is one of the most important hospital pathogens. The aim of the study was to evaluate VRE colonization in patients hospitalized at the Hematology Intensive Care Unit, as well as the associated risk factors. A prospective cohort study involved 70 patients hospitalized at the Intensive Care Unit (ICU), Clinic for Hematology, Clinical Center of Serbia, Belgrade, during 3 months. Baseline demographic data, data about antibiotic usage and other risk factors for VRE colonization during the present and previous hospitalizations (within 6 months) were recorded for each patient using the questionnaire. Feces or rectal swab was collected for culture from patients on admission and at discharge in case when VRE was not isolated on admission. Enterococci were isolated by standard microbiological methods. Isolate sensitivity was tested by disk-diffusion test using 30 microg/mL (BBL) Vancomycin plates according to the Clinical and Laboratory Standards Institute (CLSI) standard. Analysing results showed that 7% of the patients had been already colonized with VRE upon ICU admission. The rate of VRE colonization during present hospitalization was 41.5%. Univariate logistic regression demonstrated the statistically significant differences in diagnosis, length of present stay, use of aminoglycosides and piperacillin/tazobactam in present hospitalization, duration of use of carbapenem and piperacillin/tazobactam in present hospitalization between the VRE-colonized and non-colonized patients. Acute myeloid leukemia (AML), use of carbapenem in previous hospitalization and duration of use of piperacillin/tazobactam in present hospitalization were independent risk factors for VRE-colonized patients according to multivariate logistic regression. VRE colonization rate was high among the patients admitted to hematology ICU. Rational use of antibiotics and active surveillance may be helpful preventive measures against the development of bacterial resistance to antimicrobial agents.

Impact of chlorhexidine-impregnated washcloths on reducing incidence of vancomycin-resistant enterococci colonization in hematology–oncology patients

Daily skin cleansing with washcloths impregnated with chlorhexidine gluconate (CHG) of patients in intensive care unit is associated with reduction in incidence of vancomycin-resistant Enterococci (VRE) acquisition. This study describes the impact on incidence of VRE colonization after the implementation of daily skin cleansing with 2% CHG-impregnated washcloths in hematology-oncology patients. In this before-and-after study, we compared the incidence rate of VRE colonization during the baseline period (where routine soap-and-water bathing was used) with the intervention period where patients were cleansed with 2% CHG-impregnated washcloths. Acquisition of VRE decreased from 7.8% in the baseline to 3.8% in the intervention period (relative risk, 0.48, 95% confidence interval [CI], 0.21-1.09; P = .07). The crude relative rate of acquisition during the intervention period compared with the baseline period was 0.53 (95% CI, 0.23-1.23; P = .13). Patients who had been a roommate of a patient subsequently found to have VRE were at a significantly increased risk for acquiring VRE (hazard ratio, 18.8, 95% CI, 5.37-66.15; P < .001). However, patients admitted to the same bed number of previously known VRE-colonized patient were not at increased risk of VRE acquisition (hazard ratio, 0.37, 95% CI, 0.11-1.22; P = .10). We did not observe a statistically significant reduction in the rate of VRE colonization in association with the use of 2% CHG-impregnated washcloths among hematology-oncology patients.

Colonization Rate and Control of Vancomycin-Resistant Enterococci in the Neonatal Intensive Care Unit

Purpose : Recently, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in Korea. However, there have been few studies on the epidemiology of VRE colonization among neonates. In this study, we investigated the prevalence of VRE colonization, risk factors for VRE, and how to control the spread of VRE infection in the Neonatal Intensive Care Unit (NICU) of Pusan National University Hospital (PNUH). Methods : We retrospectively reviewed medical records of 192 neonates who were admitted to the NICU of PNUH from March 2006 to March 2007. Surveillance cultures from rectal swabs for detecting VRE were obtained weekly during the study period. We analyzed the prevalence of VRE and various risk factors. Results : The rate of VRE colonization among NICU patients was 25% (48/192). Thirty five of these VRE colonized patients were transferred to the NICU from other local hospitals. Compared with the non-VRE group, the risk factors associated with VRE colonization were lower birth weight, congenital heart disease, applied mechanical ventilation, use of a central venous catheter, chest tubing, a history of surgery, and use of antibiotics. Conclusion : VRE colonization among patients admitted to the NICU is rapidly increasing. Monitoring and managing premature neonates from the beginning of the birth process, avoiding many invasive procedures, avoiding antibiotics such as vancomycin and third generation cephalosporin are important for preventing the emergence and spread of VRE colonization in the NICU.

Multiply Resistant Gram-Positive Bacteria: Vancomycin-Resistant Enterococcus in Solid Organ Transplant Recipients

Enterococcus is a commonly isolated microorganism in transplant patients, especially after liver and kidney transplantation (1). The incidence of vancomycin-resistant enterococci (VRE) has increased both in the nontransplant (2–4) and transplant settings (5–7). VRE colonization was first identified in 40 liver and 13 kidney transplant patients at the Mayo Clinic in 1995 (1). The rate of VRE colonization and infection is highly variable and center-dependent and significantly more common in the United States than in Europe. Recent reports show a prevalence of colonization among liver and kidney recipients between 3.4% and 55% (6,8–10) and of infection between 4% and 11% (1,7). The majority of VRE infections occur within the first month following transplantation, although late infections have also been described.

Vancomycin-Resistant Enterococcus: Containing an Outbreak in a University-Based Children's Hospital

ISSUE: Following onset of a dramatic increase in vancomycin-resistant enterococcus (VRE) bloodstream infections (BSI) among patients (n = 7) on the bone marrow transplant unit at a university based children's hospital, a multifaceted intervention was designed to identify and isolate colonized patients, to educate healthcare workers on the importance of adherence to isolation practices, and to reduce the rate of VRE colonization in the population.

Vancomycin-Resistant Enterococcus (VRE) Colonization Is Associated with a High Rate of Bacteremia and Early Mortality in Transplant/Leukemia Patients.

Background: Vancomycin-resistant enterococci (VRE) have become increasingly important nosocomial pathogens in very ill and immunocompromised hospitalized patients (pts). Due to an increase in VRE clinical cultures including bacteremias on our institutional transplant/leukemia service in early 2004, active surveillance for VRE among this population was instituted in June 2004. We describe here the incidence and prevalence of VRE colonization and infection in this population over a two year study period, as well as selected pt demographics and mortality associated with VRE bacteremia.Methods: Between June 2004 and July 2006, active surveillance for VRE on inpatients on the transplant/leukemia service was performed by acquiring perirectal or stool swabs for VRE culture on hospital admission and on a weekly basis while inpatient. Acquisition of VRE was determined to be nosocomial if the initial culture was negative followed by a positive culture at any time during the hospital stay. Multiple sequential interventions as recommended by the Society for Healthcare and Epidemiology (SHEA) guidelines were implemented. Pt census data and daily isolation indicators were used to help determine VRE colonization rates and the prevalence of VRE on the units. Chart reviews were performed to obtain information on clinical pts related features and mortality of bacteremic pts.Results: Nineteen percent (193/1019) of pts screened were colonized with VRE with the monthly nosocomial colonization rate ranging from 2–12% (rate/1000 patient days). Eighteen percent (31/189) of pts newly colonized with VRE became bacteremic, including 7/31 who had bacteremia as their primary presentation. Of the bacteremic pts, 24 (77.4%) died at a median of 20 days (range 2–208 days), 18 (75%) dying during their bacteremic hospitalization of multiple causes. Sixteen had acute leukemia, 11 non-Hodgkin's lymphoma, and 3 other malignancies. Eighteen bacteremic pts had undergone allogeneic transplant & 5 autologous transplant. Fourteen of 18 allogeneic transplant pts had active GVHD and all 18 were on immune suppression therapy. Of all allogeneic transplants performed during the study period, 13% (18/140) were complicated by VRE bacteremia. Sixteen bacteremic pts required ICU stays, while 6 had C. difficile colitis and 5 mucositis during the same hospital stay. SHEA recommended interventions instituted at various times (e.g. enhanced contact and barrier precautions for colonized pts, “supercleans” of unit, written communication to staff, pts and families, gloving for all pt contacts) did not have a durable effect on these rates. However, the ratio of new nosocomial cases/overall prevalence of VRE in the units decreased 20% over the study period, suggesting some measure of control despite high colonization pressure. Assessment of response to intensive control strategies as well as delineation of risk factors for bacteremia and death in this population are ongoing and will be presented.Conclusion: Despite application of standardized guidelines for VRE control, affecting a marked and durable decrease in endemic VRE colonization on a complicated transplant/leukemia service is difficult. VRE bacteremia following colonization in transplant/leukemia pts is common and is associated with early mortality. VRE control remains critical, and new modalities and approaches are essential.

Prevalence of vancomycin-resistant Enterococcus fecal colonization among kidney transplant patients

BackgroundEnd stage renal disease patients are at risk of Vancomycin-Resistant Enterococcus (VRE) infections. The first reports of VRE isolation were from hemodialysis patients. However, to date, VRE fecal colonization rates as well as associated risk factors in kidney transplant patients have not yet been established in prospective studies.MethodsWe collected one or two stool samples from 280 kidney transplant patients and analysed the prevalence of VRE and its associated risk factors. Patients were evaluated according to the post-transplant period: group 1, less than 30 days after transplantation (102 patients), group 2, one to 6 months after transplantation (73 patients) and group 3, more than 6 months after transplantation (105 patients).ResultsThe overall prevalence rate of fecal VRE colonization was 13.6% (38/280), respectively 13.7% for Group 1, 15.1% for group 2 and 12.4% for group 3. E. faecium and E. faecalis comprised 50% of all VRE isolates. No immunologic variables were clearly correlated with VRE colonization and no infections related to VRE colonization were reported.ConclusionFecal VRE colonization rates in kidney transplant patients were as high as those reported for other high-risk groups, such as critical care and hemodialysis patients. This high rate of VRE colonization observed in kidney transplant recipients may have clinical relevance in infectious complications.

Prevalence of Vancomycin‐Resistant Enterococci Among Children with End‐Stage Renal Failure

To evaluate the prevalence of colonization with vancomycin-resistant enterococcus (VRE) in end-stage renal failure (ESRF), we screened the intestinal flora from 338 pediatric ESRF patients treated in 13 pediatric nephrology units in mid-Europe. Eighty-one patients were undergoing hemodialysis, 66 were undergoing chronic peritoneal dialysis, and 191 were transplant recipients. A total of 363 enterococcal strains were recovered from 232 patients. Twenty-seven enterococcal strains from 24 patients (7.1%) had reduced susceptibility to vancomycin (minimal inhibitory concentration [MIC], >4 microg/mL). Although two patients (0.6%) carried enterococci with high-level resistance to vancomycin (MIC, >32 microg/mL; i.e., VRE), strains of enterococcus with reduced susceptibility to vancomycin (ERSV) were recovered from the other 22 subjects. Past use of vancomycin (P = .05) and tacrolimus therapy (P = .011) were independent risk factors for ERSV or VRE carriage. Enterococcal infections occurred with a similar frequency among enterococcal carriers and noncarriers; no infections with VRE or ERSV were reported. In conclusion, the prevalence of ERSV carriage and the rate of VRE colonization among mid-European children and adolescents with ESRF currently are moderate and low, respectively.

Epidemiology and control of vancomycin-resistant enterococci in a regional neonatal intensive care unit.

After the occurrence of two cases of bloodstream infection with vancomycin-resistant enterococci (VRE) in our regional neonatal intensive care unit, we studied the epidemiology of VRE and applied extensive infection control measures to the unit to control VRE transmission. Infection control measures applied to the unit included weekly surveillance for VRE colonization; education; cohorting of VRE-positive, VRE-negative and VRE-exposed babies with separate personnel and equipment for each group; use of gowns and gloves on room entry; and hand washing before and after each patient contact. Risk factors for VRE colonization were determined with a stepwise logistic regression model. Thirty-three (40.2%) babies became colonized with VRE. The VRE colonization rate was reduced from 67% to 7% after implementation of infection control measures. Prolonged antimicrobial treatment and low birth weight were significantly associated with an increased risk of VRE colonization. VRE can spread rapidly among newborns in a regional neonatal intensive care unit. Strict infection control measures can reduce the rate of VRE colonization among neonates.

CONTROL OF VANCOMYCIN RESISTANT ENTEROCOCCI COLONIZATION IN A REGIONAL NEONATAL ICU. † 1770

Vancomycin resistant enterococcus (VRE) is potentially lethal in critically ill neonates. We studied the rate of VRE colonization and assessed the effectiveness of our control measures in our Regional Neonatal ICU (RNICU) and Intermediate Care Nursery (ICN) after finding two patients within a 3 day period with blood cultures growing VRE. RNICU and ICN are functionally separate units with their own medical and nursing staff.