Rates Of Vancomycin-resistant Enterococci Research Articles

Impact of the coronavirus disease 2019 pandemic on the incidence of other infectious diseases in the hematology hospital in Korea.

Since the coronavirus disease 2019 (COVID-19) outbreak, hospitals have implemented infection control measures to minimize the spread of the virus within facilities. This study aimed to investigate the impact of COVID-19 on the incidence of healthcare-associated infections (HCAIs) and common respiratory virus (cRV) infections in hematology units. This retrospective study included all patients hospitalized in Catholic Hematology Hospital between 2019 and 2020. Patients infected with vancomycin-resistant Enterococci (VRE), carbapenemase-producing Enterobacterales (CPE), Clostridium difficile infection (CDI), and cRV were analyzed. The incidence rate ratio (IRR) methods and interrupted time series analyses were performed to compare the incidence rates before and after the pandemic. The incidence rates of CPE and VRE did not differ between the two periods. However, the incidence of CDI increased significantly (IRR: 1.41 [p = 0.002]) after the COVID-19 pandemic. The incidence of cRV infection decreased by 76% after the COVID-19 outbreak (IRR: 0.240 [p < 0.001]). The incidence of adenovirus, parainfluenza virus, and rhinovirus infection significantly decreased in the COVID-19 period (IRRs: 0.087 [p = 0.003], 0.031 [p < 0.001], and 0.149 [p < 0.001], respectively). The implementation of COVID-19 infection control measures reduced the incidence of cRV infection. However, CDI increased significantly and incidence rates of CPE and VRE remained unchanged in hematological patients after the pandemic. Infection control measures suitable for each type of HCAI, such as stringent hand washing for CDI and enough isolation capacities, should be implemented and maintained in future pandemics, especially in immunocompromised patients.

High Gastrointestinal Colonization Rate of Vancomycin-Resistant Enterococci among Hospitalized Patients: Potential Source for Resistant Gene.

Vancomycin-resistant Enterococci (VRE) is a global health problem and responsible for healthcare-associated infections (HAIs) in patients with prolonged hospital stay, severe underlying disease, and previous broad-spectrum antibiotic therapy. These bacteria can cross-resist and transfer drug-resistant genes to other potentially pathogenic bacteria. Therefore; this study was aimed to determine the gastrointestinal colonization rate of VRE, its antimicrobial susceptibility profile, and associated factors among hospitalized patients. Prospective cross-sectional study was conducted using stool samples from 223 patients admitted to different wards at Hawassa University Comprehensive Specialized Hospital, from April 1 to June 30, 2021. Patients admitted to the hospital for more than 48 hours for various medical conditions were included. Sociodemographic and clinical characteristics were collected using a structured questionnaire. Fecal specimens were cultured on Enterococci selective media. Enterococcus species were identified using their growth and mannitol fermentation properties. Vancomycin resistance was screened using both the Kirby-Bauer disk diffusion method and a vancomycin E-test strip. Data were entered and analyzed using SPSS version 25. Descriptive and logistic regressions were used to determine the frequency and association of factors with the VRE colonization rate. A p value of <0.05 was considered statistically significant. A total of 223 fecal specimens were collected and processed, and 141 (63.2%) them were positive for Enterococci. The predominant species was E. faecalis 65 (46.1%) followed by E. faecium 76 (53.9%). In this study, the gastrointestinal colonization rate of VRE was 15 (6.7%) and all the species belong to E. faecium. Study participants who had no formal education (AOR = 4.26, 95% CI: 1.01, 18.06), hospitalized patients for >2 weeks (AOR = 4.10, 95% CI: 1.08, 15.57), and those who had a history of treatment with vancomycin (AOR = 4.77, 95% CI: 1.26, 18.09) were more likely to be colonized with vancomycin-resistant Enterococci. More than 95% of Enterococci isolates were susceptible to linezolid, whereas 70.2%, 63.1%, 56.7%, and 53.9% were resistant to tetracycline, erythromycin, penicillin, and ampicillin, respectively. Among the total Enterococci isolated, 141 (54.6%) were multidrug resistant. In our study, high proportion of vancomycin-resistant Enterococci was found. Previous exposure to antibiotics and hospital stay were significant factors for VRE gut colonization. The isolated Enterococci showed variable degrees of resistance to commonly prescribed antibiotics which leads to a worldwide problem multidrug resistance. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics, and implementing infection prevention protocols may reduce colonization by VRE.

2486. Winners and Losers: MDROs In The Time of COVID-19

Abstract Background NUH is a 1200 bed academic medical center in Singapore, with endemic multi-drug resistant infections (MDROs) including carbapenemase-producing Enterobacterales (CPE), vancomycin-resistant Enterococci (VRE), Clostridioides difficile infection (CDI), and multi-drug resistant(MDR) Acinetobacter spp. (AB), and MDR Pseudomonas aeruginosa (PA). We studied the impact of COVID-19 (C19) restrictions on the prevalence of hospital acquired (HA) MDROs. Methods A HA infection is defined as a positive clinical culture after hospital day 3. The rates of key MDROs were reviewed from 2018 to the start of the zero C19 policy in Feb 2020 through the lifting of zero COVID in Aug 2021 (Delta Surge) with services still diverted until Jan 2022, when the hospital policy shifted to Endemic C19 (all clinical services resumed). Incidence rates (IR) are expressed per 10,000 patient days, and incidence rate ratios (IRR) estimated for each time period, with p&amp;lt; 0.05 considered statistically significant. We compared DDD per 100 patient days of carbapenem usage for each time period.Table 1:Incidence rates of HO CPE, VRE, CDI, and MDR AS, KP, PA, comparing pre-pandemic 2018-2019, pandemic 2020-2021, and post-pandemic 2022-March 2023Table 2:Incidence rate ratios of HO CPE, VRE, CDI, and MDR AS, KP, PA, comparing pre-pandemic 2018-2019, Zero-COVID 2020 July 2021, Delta surge Aug- Dec 2021-and Endemic COVID Jan 2022- 2023 Results While HA-MDRAB rates declined during the zero C19 period, VRE and CDI rates were stable. CPE rates decreased during the pandemic but have almost doubled post-pandemic from 0.37 in the pandemic to 0.69 post-pandemic (p&amp;lt; 0.05). The mean DDD per 100 patient days for carbapenem usage pre-pandemic was 5.24 and fell to 4.64 (p&amp;lt; 0.05) in 2020-2021.Figure 3:Incidence rates of MDROs that significantly trended downwards during the zero COVID and the Delta surge periods.Figure 4:Incidence rates of VRE and CDI appeared stable, while CPE increased post-pandemic 2022-March 2023Figure 5:Procurement of alcohol-based hand rub pre-pandemic, during pandemic, and post-pandemic Conclusion Studies globally report increased MDROs during the pandemic, purportedly due to reuse of PPE and other reasons. We experienced either a significant decrease or no change in many MDRO clinical infections, followed by a rebound since Jan 2022, when all hospital services resumed (Endemic C19). Our decrease in MDROs may be due to our zero C19 policy, increased hand hygiene, enhanced PPE adherence and cleaning regimens, a decrease in our carbapenem usage (p&amp;lt; 0.05 Table 6), and reduced elective surgeries and admissions, including overseas patients . After endemicity, we had a rebound in CPE infections, and other MDROs possibly triggered by HH and PPE fatigue (Fig. 5), the return of medical tourists and elective surgeries. Further prospective studies are needed to better understand the epidemiology of the various MDROs and the impact of draconian measures such as the Asian Zero C19 approach.Table 6:Defined daily dose of antibiotics per 100 patient days (by quarter) Disclosures All Authors: No reported disclosures

Impact of improving infection control and antibiotic stewardship practices on nosocomial infections and antimicrobial resistance in an oncology centre from India

BackgroundImproving basic infection control (IC) practices, diagnostics and anti-microbial stewardship (AMS) are key tools to handle antimicrobial resistance (AMR). Materials and methodsThis is a retrospective study done over 6 years (2016–2021) in an oncology centre in North India with many on-going interventions to improve IC practices, diagnostics and AMS. This study looked into AMR patterns from clinical isolates, rates of hospital acquired infections (HAI) and clinical outcomes. ResultsOver all, 98,915 samples were sent for culture from 158,191 admitted patients. Most commonly isolated organism was E. coli (n ​= ​6951; 30.1%) followed by Klebsiella pneumoniae (n ​= ​5801; 25.1%) and Pseudomonas aeroginosa (n ​= ​3041; 13.1%). VRE (Vancomycin resistant Enterococcus) rates fell down from 43.5% in Jan–June 2016 to 12.2% in July–Dec 2021, same was seen in CR (carbapenem resistant) Pseudomonas (23.0%–20.6%, CR Acinetobacter (66.6%–17.02%) and CR E. coli (21.6%–19.4%) over the same study period. Rate of isolation of Candida spp. from non-sterile sites also showed reduction (1.68 per 100 patients to 0.65 per 100 patients). Incidence of health care associated infections also fell from 2.3 to 1.19 per 1000 line days for CLABSI, 2.28 to 1.88 per 1000 catheter days for CAUTI. There was no change in overall mortality rates across the study period. ConclusionThis study emphasizes the point that improving compliance to standard IC recommendations and improving diagnostics can help in reducing the burden of antimicrobial resistance.

VANCOMYCIN RESISTANT ENETROCOCCI- A STUDY ON PREVALENCEOF VANCOMYCIN RESISTANCE ENTEROCCI IN A TERTIARY CARE HOSPITAL IN SOUTH KERALA

Introduction: Vancomycin-resistant enterococci (VRE), are bacterial strains of the genus Enterococcus that are resistant to the antibiotic vancomycin. They have been associated with outbreaks of hospital-acquired (nosocomial) infections around the world. VRE can remain viable in the environment for an extended time period posing a problem for infection control in hospitals and nursing homes. They also pose a major therapeutic challenge as they possess intrinsic resistance to most of the commonly used antibiotics and can acquire resistance to most of the current available antibiotics. Assessment of the prevalence and changing trends of VRE infections is required to help plan infection control measures, which should be implemented in the hospital and also in the community to reduce the mortality and morbidity caused by these VRE infections. Objectives: This study was undertaken to determine the prevalence of Vancomycin resistance among Enterococcus species isolates obtained from clinical samples in a tertiary care hospital in southern India and also to detect resistant genes by molecular methods. A descriptive cross- Methods: sectional study was done on 150 non-duplicate isolates of Enterococcus species from different samples received at the Microbiology laboratory of Sree Gokulam Medical College and Research Foundation included consecutively from January 2021 to December 2021. Identication was based on Gram staining, colony morphologies, and biochemical tests. Antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method on Mueller Hinton agar. Vancomycin resistance was determined by Vancomycin screen agar and vancomycin E -test method. Statistical Package for Social Sciences (SPSS) was used for preparing and analysis of data. Out of the Results: 150 Enterococcus species, 2% (3) isolates were resistant to Vancomycin by Vancomycin screen agar &amp; Vancomycin MIC test in which 2 were E. faecium and 1was E. faecalis. Out of 3 VRE, all were sensitive to Teicoplanin, so they were likely of vanB phenotype. Vancomycin resistant Enteroc Conclusion: occus species have emerged as important nosocomial pathogens in our institution with resistance of 2% per cent in our study. Increasing trend in the VRE rates, as seen in India and worldwide, need to be monitored and checked with active surveillance.

A Six-Year Retrospective Study of Microbiological Characteristics and Antimicrobial Resistance in Specimens from a Tertiary Hospital's Surgical Ward.

Surgery has revolutionized the practice of medicine by allowing the treatment of conditions amenable to conservative medical management with some of them pathophysiologically involving the prevalence of pathogenic microorganisms. On the other hand, infections such as surgical site infections or urinary tract infections may complicate patients hospitalized in surgical wards leading to considerable morbidity, mortality, and increased healthcare-associated costs. The aim of this study was to present the microbiological characteristics and antimicrobial resistance of all isolates identified in microbiological specimens from a surgical ward of a tertiary hospital in Greece during a six-year period. Only specimens that yielded at least one microorganism were included in the analysis. In total, 1459 strains in 789 positive cultures were isolated. The most common sample sent to the microbiology department was pus from surgical wounds. The most common pathogens among all 1459 strains isolated were Enterobacterales at 33% (n = 482), however, the most common genus was Enterococcus at 22.3% (n = 326). Antimicrobial resistance against third-generation cephalosporins was 23% (n = 111/482) among Enterobacterales, while, the rate of vancomycin-resistant enterococci (VRE) was 18.5% (n = 60/324) among Enterococcus species and was increasing in the last years of the study. Antimicrobial resistance of Acinetobacter baumannii to carbapenems was 68.8% (n = 11/16), which was lower than the corresponding rate in other wards in Greece. The antimicrobial resistance rates noted herein raise questions regarding the appropriateness of currently suggested antimicrobials in guidelines and imply that a revision could be required. Practicing clinicians should always be aware of local microbiological data that allow the selection of appropriate antimicrobials for the management of infections. Finally, the increasing rates of VRE noted herein mandate further actions from the point of infection control and antimicrobial stewardship.

MRSA Prophylaxis in Spine Surgery Decreases Postoperative Infections.

Retrospective cohort study. To compare infection rates before and after the implementation of a quality improvement protocol focused on methicillin-resistant Staphylococcus aureus (MRSA) screening and decolonization in patients undergoing lumbar fusion and/or decompression. Prior studies have demonstrated MRSA infections comprise a sizable portion of SSIs. Additional studies are required to improve our understanding of the risks and benefits of MRSA decolonization with vancomycin prophylaxis. A retrospective cohort analysis was conducted on patients who underwent spinal fusion or laminectomy before (2008-2011) and after (2013-2016) the implementation of an MRSA screening and treatment protocol. Odds ratios for MRSA, methicillin-sensitive Staphylococcus aureus (MSSA), and Vancomycin-resistant Enterococcus (VRE) infection before and after screening was calculated. Multivariate analysis assessed demographic characteristics as potential independent predictors of infection. A total of 8425 lumbar fusion and 2558 lumbar decompression cases met inclusion criteria resulting in a total cohort of 10,983 patients. There was a significant decrease in the overall rate of infections ( P <0.001), MRSA infections ( P <0.001), and MSSA infections ( P <0.001) after protocol implementation. Although VRE infections after protocol implementation were not significantly different ( P =0.066), VRE rates as a percentage of all postoperative infections were substantially increased (0 vs. 3.36%, P =0.007). On multivariate analysis, significant predictors of the infection included younger age (OR=0.94[0.92-0.95]), shorter length of procedure (OR=1.00[0.99-1.00]), spinal fusion (OR=18.56[8.22-53.28]), higher ASA class (OR=5.49[4.08-7.44]), male sex (OR=1.61[1.18-2.20]), and history of diabetes (OR=1.58[1.08-2.29]). The implemented quality improvement protocol demonstrated that preoperative prophylactically treating MRSA colonized patients decreased the rate of overall infections, MSSA infections, and MRSA infections. In addition, younger age, male sex, diabetic status, greater ASA scores, and spinal fusions were risk factors for postoperative infection.

The Role of Emergency Departments in Cross-Contamination: The Case of VRE

Colonized surfaces, equipment, individuals, and infected patients can be sources for the hospital spread of vancomycin-resistant enterococci (VRE), which is one of the important nosocomial pathogens. The basic epidemiological tools for the prevention and control of hospital-acquired infections are the typing methods. Pulsed-field gel electrophoresis (PFGE) is a highly discriminating method used frequently to detect clonal associations in epidemics and hospital-acquired VRE infections. This study aimed to investigate the presence of cross-contamination, which service or services come to the forefront in case of possible cross-contamination and clonal relationship between VRE strains isolated from rectal swab, clinical and environmental swab samples taken in two different periods in various clinics of Istanbul University Istanbul Medical Faculty Hospital by PFGE method. A total of 125 VREs isolated in two different periods were included in the study. Rectal and environmental swab samples were inoculated on Enterococcosel agar and sodium azide broth, urine samples were inoculated on chromogenic agar, and other clinical samples were inoculated on 5% sheep blood agar and incubated for 18-24 hours. VITEK 2 Compact automation system GP panel (bioMerieux, MarcyL'Etoile, France) was used for the species identification of catalase-negative, gram-positive colonies and disc diffusion and minimum inhibitory concentration (MIC) gradient tests were used to determine vancomycin susceptibility. Multiplex polymerase chain reaction was used to search for vanA and vanB resistance genes in isolates identified as VRE, and PFGE was used to determine clonal association. All isolates were identified as Enterococcus faecium with the vanA resistance gene. It was shown that PFGE clones were divided into six types with 65% similarity (A-F), and in this polyclonal spread, the major type was type A, which contained 108 isolates in 37 subtypes existed in the hospital for years. In patients from whom similar isolates were obtained, the high rate of hospitalizations in the same emergency room or in different emergency services in the same building drew attention. Our results showed that the presence of VRE was established in our hospital, new isolates were added from time to time, and there was a cross-contamination. It was observed that emergency services, where infection control measures were neglected due to working conditions, were among the high-risk areas for VRE contamination. In order to better understand the importance of emergency services in cross-contamination, it would be useful to conduct surveillance studies among patients hospitalized in emergency services and monitor the rate of VRE in the services where positive patients were transferred.

Epidemiological features of infections/colonization, caused by vancomycin-resistant enterococci in Saint-Petersburg hospitals in 2017–2020

Relevance. Enterococcus are ubiquitous, and can cause various infections, up to endocarditis. Vancomycin-resistant enterococcus (VRE) infections are difficult and expensive to treat. According to the AMRmap (Online Platform for Analysis of Antimicrobial Resistance Data in Russia) data for 2017–2020, VRE cases were reported in all federal districts of the Russian Federation, with one of the highest VRE rates in St. Petersburg (4.27%, 95% confidence interval [95% CI] 2.1–8.6)). But further, larger studies in each region are required. Aims. The study is to identify the epidemiological features of infections/colonization caused by VRE in Saint-Petersburg hospitals in 2017–2020. Materials and methods. A retrospective analysis of the prevalence of VRE isolated from hospital patients (51 hospitals of various profiles) in St. Petersburg for the period from 2017 to 2020 was performed. Results. During the study period, VRE rate was 5.3% (95% CI 5.1–5.6). The highest proportion (11.6%, 95% CI 10.4–13)) and incidence (0.6 per 1000 patients) of VRE was observed in children hospitals, the lowest – in maternity homes 0.5% (95% CI 0.3– 0.7). Throughout the analysis period VRE were detected in clinical specimens of patients from most of the departments. In adult hospitals, the proportion of VREs was significantly higher in oncohematology 14.6% (95% CI 9.6–21.7), neurology 10.8% (95% CI 7.4–15.6), and intensive care units 10.1% (95% CI 9.4–11.0). In 2020, there was a dramatic increase in VREs in neurology, cardiology, and infection departments in adult hospitals. Neonatology and intensive care units in children hospitals had the highest proportion of VRE, 40.7% (95% CI 34–48.3) and 29.8% (95% CI 21.04–40.3), respectively. In departments of other profiles, this rate varied from year to year, which may be related with clusters in hospitals and departments. Sporadic cases were detected in both neonatal and obstetric departments of maternity homes. The most common clinical specimen with isolated VRE was urine; this was characteristic of departments of almost all profiles and for children intensive care patients also VRE was isolated in gastric fluid and feces often. Conclusions. The proportion of VRE isolated from clinical specimens from patients in St. Petersburg hospitals is at an average level compared to other regions of the Russian Federation and other countries. The highest prevalence of VRE was noted in pediatric hospitals. Risk groups are patients of neonatology and intensive care departments in children's hospitals and oncohematology, neurology and intensive care departments in adult hospitals. VRE are most commonly found in the urine of patients. Screening for VRE among patients in at-risk units and contact precautions should be taken to VRE-infected/colonized patients.

32. Impact of a Four-Year Antimicrobial Stewardship Program on Antimicrobial Resistance

Abstract Background Antimicrobial resistance (AMR) is an increasing threat to public health and antimicrobial consumption is a primary driver of resistance. Many studies have shown that the implementation of an antibiotic stewardship program (ASP) improves prescribing of antibiotics and can reduce AMR. Purpose of the study was to assess the impact of a successful ASP, implemented for four years, on AMR in our 427-bed tertiary general hospital. Methods We monitored pharmacy data for the years 2015 (pre-intervention) and 2016-2019 (post-intervention) for antibiotic consumption (DDD/100 bed-days) and resistance rates. AMR data were obtained from the clinical microbiology laboratory’s electronic database. To achieve the goals of ASP we used a range of interventions as pre-authorization strategy for the protected antibiotics (tigecycline, carbapenems, quinolones, glycopeptides, daptomycin, colistin, linezolid), prospective audit and feedback with direct intervention, de-escalation or switch from iv to oral administration and appropriate selection and duration of chemoprophylaxis in surgery. Results Significant reductions were observed for: total antibiotics, colistin, carbapenems, quinolones and tigecycline consumption during study period. Significantly lower resistance rates were documented in 2019 compared to 2015 for Pseudomonas aeruginosa and for Klebsiella pneumoniae. As for Acinetobacter baumannii isolates, which in our hospital are highly-resistant exhibiting &amp;gt;90% resistance to carbapenems, no significant changes were noted during the study period. Infections caused by Gram-positive pathogens are less prevalent in our hospital. Lower rates of vancomycin-resistant enterococci were noted after the implementation of our ASP (30.4% in 2019 vs. 50.0% in 2015 for E. faecium and 0.6% vs. 6% for E. faecalis, respectively), whereas methicillin-resistant S. aureus isolates increased (40% in 2019 vs. 31.1% in 2015), possibly because most of these infections were not hospital-acquired. Resistance rates of Pseudomonas and Klebsiella Conclusion Our ASP was successful in reducing antibiotic consumption and AMR for important pathogens. Disclosures All Authors: No reported disclosures

Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia

Broad-spectrum antibiotics administered to patients with severe COVID-19 pneumonia pose a risk of infection caused by Clostridioides difficile. This risk is reduced mainly by strict hygiene measures and early de-escalation of antibiotic therapy. Recently, oral vancomycin prophylaxis (OVP) has also been discussed. This retrospective study aimed to assess the prevalence of C. difficile in critical COVID-19 patients staying in an intensive care unit of a tertiary hospital department of anesthesiology, resuscitation, and intensive care from November 2020 to May 2021 and the rates of vancomycin-resistant enterococci (VRE) after the introduction of OVP and to compare the data with those from controls in the pre-pandemic period (November 2018 to May 2019). During the COVID-19 pandemic, there was a significant increase in toxigenic C. difficile rates to 12.4% of patients, as compared with 1.6% in controls. The peak rates were noted in February 2021 (25% of patients), immediately followed by initiation of OVP, changes to hygiene precautions, and more rapid de-escalation of antibiotic therapy. Subsequently, toxigenic C. difficile detection rates started to fall. There was a nonsignificant increase in VRE detected in non-gastrointestinal tract samples to 8.9% in the COVID-19 group, as compared to 5.3% in the control group. Molecular analysis confirmed mainly clonal spread of VRE.

Ultraviolet-C Light Evaluation as Adjunct Disinfection to Remove Multidrug-Resistant Organisms.

BackgroundOur objective was to determine if the addition of ultraviolet-C (UV-C) light to daily and discharge patient room cleaning reduces healthcare-associated infection rates of vancomycin-resistant enterococci (VRE) and Clostridioides difficile in immunocompromised adults.MethodsWe performed a cluster randomized crossover control trial in 4 cancer and 1 solid organ transplant in-patient units at the Johns Hopkins Hospital, Baltimore, Maryland. For study year 1, each unit was randomized to intervention of UV-C light plus standard environmental cleaning or control of standard environmental cleaning, followed by a 5-week washout period. In study year 2, units switched assignments. The outcomes were healthcare-associated rates of VRE or C. difficile. Statistical inference used a two-stage approach recommended for cluster-randomized trials with <15 clusters/arm.ResultsIn total, 302 new VRE infections were observed during 45787 at risk patient-days. The incidence in control and intervention groups was 6.68 and 6.52 per 1000 patient-days respectively; the unadjusted incidence rate ratio (IRR) was 0.98 (95% confidence interval [CI], .78 − 1.22; P = .54). There were 84 new C. difficile infections observed during 26118 at risk patient-days. The incidence in control and intervention periods was 2.64 and 3.78 per 1000 patient-days respectively; the unadjusted IRR was 1.43 (95% CI, .93 − 2.21; P = .98).ConclusionsWhen used daily and at post discharge in addition to standard environmental cleaning, UV-C disinfection did not reduce VRE or C. difficile infection rates in cancer and solid organ transplant units.

Increasing Trend of Vancomycin-resistant Enterococci Bacteremia in a Tertiary Care Hospital of South India: A Three-year Prospective Study.

ABSTRACTIntroduction: Vancomycin-resistant enterococci (VRE) are emerging as an important multidrug-resistant pathogen causing nosocomial infections, predominantly bacteremia and urinary tract infections. VRE bacteremia has caused a significant increase in the duration of the hospital stay and mortality and had caused high public health threat due to limited treatment options.Materials and methods: Between October 2017 and September 2020, all consecutive patients with culture-proven bloodstream infection with Enterococcus species, isolated for the first time, were included in the study. A total of 427 Enterococcus species were identified, and antimicrobial susceptibility tests were performed and interpreted using Clinical and Laboratory Standard Institute guidelines.Results: Of the total 427 Enterococcus species isolated, 63 (45.6%) were VRE. Among them, 51/63 (81%) were Enterococcus faecium (E. faecium) and 5/63 (8%) were Enterococcus faecalis. There was an increased trend of VRE rate in the bloodstream infections of 6.12% (2018), 13.2% (2019), and 19.2% (2020). The majority of the VRE patients [43/63 (68%)] were admitted to the intensive care units (ICUs). Vancomycin A (VanA) is the most common phenotype isolated from 51/63(81%) patients.Conclusion: This increasing trend of VRE bacteremia is a red alert to the clinicians and the infection control practitioners, so that strict antibiotic policies and proper adherence to the infection control practices can be initiated to reduce the VRE rate.How to cite this article: Sivaradjy M, Gunalan A, Priyadarshi K, Madigubba H, Rajshekar D, Sastry AS. Increasing Trend of Vancomycin-resistant Enterococci Bacteremia in a Tertiary Care Hospital of South India: A Three-year Prospective Study. Indian J Crit Care Med 2021;25(8):881–885.

Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

Prevalence of vancomycin-resistant enterococci in Asia-A systematic review and meta-analysis.

The rise of vancomycin-resistant enterococci (VRE) has been a major health problem in most countries of the world including Asia, since its discovery. There is a paucity of data on VRE in many countries of Asia as well as limited pooled estimates. Therefore, we performed a systematic review and meta-analysis to estimate a pooled prevalence of VRE in Asia. A literature search in electronic databases like PubMed, Embase and Google Scholar and manual searching of references and grey literature, comprising the information on the prevalence of VRE with at least two species of enterococci, conducted in different countries of Asia from January 1, 2000, to September 20, 2020, was done. The random-effect model and 95% CIs was used to calculate the pooled prevalence. Subgroup, sensitivity and meta-regression analyses were performed to address heterogeneity while Egger's test for publication bias. We identified 39 studies, comprising a total of 11,875 enterococcal isolates. The result of the analysis showed that the pooled prevalence of VRE in Asia was 8.10% (95% CI; 7-9; I2 =93.79%; p<0.001). Resistance to vancomycin was greater among strains of E.faecium compared to the strains of E.faecalis (22.40% vs. 3.70%). Amongst various regions of Asia, the highest prevalence of VRE was found in the Western Asian region and the lowest in the South-east Asian region. Moreover, the rate of VRE was higher than most European countries and lower than USA. With an upsurge of VRE in Asia in recent years, efficient infection control programmes, robust surveillance systems and adherence to antibiotic stewardship are paramount to halt the further rise of VRE.

Early Detection and Prediction of Infection using Infrared Thermography

Helicobacter pylori infection causes gastritis and gastric ulcers and associated gastric cancer. Approximately 50% of the world's population H pylori infection. Developing countries with high prevalence rates. In most individuals, low socio economic means and infections are acquired during childhood. Affected family members at higher risk for childhood acquisi tion. The definitive routes of transmission are not clear evidence oral-oral, gastro-oral and fecal-oral routes of transmission. If left untreated, H pylori infection can last a lifetime. The disease is usually clinical and often occurs decades after the initial infection. H pylori infection can cause gastritis in children. Lesions, mucus-associated lymphoid lymphoma, and rarely, intes tinal metaplasia with/without gastric dysplasia.Synovial fluid aspirates were analyzed total knee arthroplasty by polymerase chain reaction in 50 patients with symptoms. Its presence indicates a bacterial infection called deoxyribonucleic acid. Syn ovial fluid samples were processed using a rapid bacterial degradation and extracts are amplified using protocol polymerase chain reaction and products analyzed including universal bacterial primers polymerase chain reaction deoxyribonucleic acid compound. A total of 32 samples were positive for bacterial infection with pre-polymerase chain reaction aspirates. We ana lyzed antimicrobial use in 509 episodes with microbiology laboratory report implications. Antibiotic stewardship. Most the rapeutic interventions occurred during phlebotomy and results by telephone after reporting gram stain release antimicrobial susceptibility data were limited impact on microbial management.A significant cause of hospitalization is leading to infection North America the second leading cause of death children and under after 1 year of malaria worldwide. Because of its global and human health impact, relatively few treatments exist. Paradoxically, there is a huge amount of information available on RSV replication during purification, RSV-induced mechanisms and social spread. RSV adds to the high burden of infection with existing chronic respiratory diseases.A major concern in clinical practice is vancomycin-resistant enterococci (VRE). Increased prevalence and their potential other bacteria to develop resistance to vancomycin (including methicillin-resistant Staphylococcus aureus) subjected them to closer scrutiny and intensive investigation. Colonialism was generally acquired high colonization rate of VRE in patients surrounding susceptible hosts.

Circulation of Vancomycin-Resistant Enterococci in Health Facilities of the Karachay-Cherkess Republic

Introduction. Gram-positive enterococci are an integral part of the normal intestinal microflora. However, if they get into wounds or sterile cavities of the body, they may induce various diseases including wound infections, urethritis, peritonitis, sepsis, pyelonephritis, or damage other organs. These microorganisms also induce nosocomial infections and are among the causative agents of health care-associated infections (HAIs); thus, it is critical to control the spread of enterococci. Our purpose was to monitor circulation of vancomycin-resistant enterococci (VRE) in health facilities of the Karachay-Cherkess Republic (KCR) in 2016-2018. Materials and methods. We studied VRE strains isolated in the Microbiological Laboratory of the Center for Hygiene and Epidemiology in the Karachay-Cherkess Republic. During three years, the total of 281 strains of vancomycin-resistant enterococci were isolated from various biological materials received from obstetric, surgical, pediatric, and therapeutic hospitals and from outpatients undergoing treatment in polyclinics of the Karachay-Cherkess Republic. Results. According to our data, VRE rates per 100 examined patients were 2.34 in 2016, 3.4 in 2017, and 3.03 in 2018, and were comparable to the rates registered in the Russian Federation in the range of 3% to 22.7%. Discussion. When analyzing circulation of vancomycin-resistant enterococci, we established that the highest VRE rate (4.24 per 100 examined patients) was observed in maternity hospitals, while the lowest rate of 0.67% was observed in therapeutic departments. When studying sensitivity of 281 isolated VRE strains to eight antibacterial drugs, no strain resistant to all antibiotics was revealed. Sensitivity to linezolid, ampicillin, and penicillin was observed in 92.6%, 79.0%, and 66.2% of strains. Sensitivity to ciprofloxacin, gentamicin, tetracycline, and nitrofurantoin was 50% or less. VRE were mainly isolated from urine and discharge from the cervical canal and pharynx.

Rektal Tarama Örnekleri ile Klinik Örneklerde Üreyen Vankomisine Dirençli Enterokokların İrdelenmesi: Yedi Yıllık Sürveyans, Retrospektif Kesitsel Bir Çalışma

Vancomycin-resistant enterococci (VRE) are multidrug-resistant microorganisms that cause nosocomial infections, prolong hospital stay and cause mortality. Current recommendations are active surveillance, screening and contact isolation to prevent the spread of VRE positivity among patients. It has been observed that the failure of the systematic screening caused the spread of VRE and increased costs. It was aimed to determine vancomycin resistance rates in Enterococcus spp., which was grown from rectal swab samples and clinical samples sent for screening of hospitalized patients between January 2013 and May 2019, to investigate the distribution of resistant isolates to departments. A rectal swab sample for VRE screening was obtained from each patient admitted to intensive care units in our hospital, and subcultured onto VRE chromogenic medium (Gül Laboratories, Turkey). The susceptibility of the isolates to vancomycin (30 μg) was detected by Kirby-Bauer disk diffusion method in accordance with the Clinical and Laboratory Standards Institute (CLSI) criteria. The VITEK2 Compact automated system was used to determine the vancomycin susceptibility of enterococci isolated from clinical samples. VRE growth was detected in 316 (6 %) of the 5249 rectal swab samples sent to the laboratory, and vancomycin resistance was detected in 51 (3.9 %) of 1306 Enterococcus spp. from clinical specimens. Of the 51 isolates with vancomycin resistance, 80 % were isolated from urine, 14 % from blood, 4 % from wound, and 2% from joint fluid. While the VRE rate in rectal swab samples was 5.5 % in 2013, it increased to 11.6 % in 2019. Vancomycin resistance was 1.6 % in 2013 and peaked at 7.7 % in 2017 in Enterococcus spp. Twenty nine percent of the 51 clinical VRE isolates were grown from patients with VRE positive rectal swabs. The highest rate of VRE growth in rectal swab samples and culture samples was observed in the Anesthesia Intensive Care Unit. No relationship was found between VRE positivity decrease and increase rates of rectal swab and clinical samples over the years. In order to prevent the spread of VRE in the hospital environment, it is necessary to take surveillance cultures regularly in centers, to provide necessary training to hospital staff, to control the use of antimicrobials, and to ensure good cooperation between the microbiology laboratory and services.

Assessing the intestinal carriage rates of vancomycin-resistant enterococci (VRE) at a tertiary care hospital in Hungary

Excessive use of antibiotics contributes to the selection of resistant bacteria and intestinal colonization with multiresistant pathogens poses a risk factor for subsequent infections. The present study assessed vancomycin-resistant enterococci (VRE) carriage rates in patients admitted to our tertiary care hospital. Stool samples sent for routine culturing were screened with vancomycin containing solid or broth enrichment media. VRE isolates were identified with matrix-assisted laser desorption/ionization-time of flight mass spectrometry and antibiotic susceptibilities were tested by E-test. Vancomycin resistance genes were detected by polymerase chain reaction. Medical records of carriers were examined for suspected risk factors for colonization. Altogether 3025 stool specimens were analyzed. Solid media identified a VRE carriage rate of 2.2% while broth enrichment detected 5.8%. Seventy percent of the isolates were Enterococcus faecium. VanB genotype was detected in 38.2%, VanA in 37.3%, VanC1 in 22.6%, and VanC2 in 1.9%. All VRE were sensitive to linezolid, daptomycin, and tigecycline. Collective risk factors for carriage were diabetes, normal flora absence, Clostridioides difficile positivity, longer hospital stay, and advanced age. 78.5% of the carriers received antibiotic therapy which was metronidazole in most cases (47.3%). We recommend regular screening of risk groups such as patients with diabetes, history of recent hospitalization, or former C. difficile infection as an imperative step for preventing VRE dissemination.

Epidemiology and risk factors of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci infections in Zhejiang China from 2015 to 2017

BackgroundGram-positive bacteria are dangerous and challenging agents of infection due to their increasing resistance to antibiotics. We aim to analyse the epidemiology and risk factors of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) in Zhejiang China.MethodsGram-positive bacteria (including S. aureus, Enterococcus faecalis and Enterococcus faecium) were collected from eighty-six hospitals of eleven cities in Zhejiang China from 2015 to 2017. The detection rates of MRSA and VRE infection were calculated for the non-duplicated isolate according to year, region, hospital level, patient age, specimen type and patient category. Meanwhile, the detected resistances of MRSA, E. faecalis and E. faecium to different antibiotics from 2015 to 2017 were compared. The risk factors and the differences in MRSA and VRE detection rates were compared using odds ratio (OR) with 95% confidence interval (95% CI) and Chi-square test respectively.ResultsFrom 2015 to 2017, the detection rates of MRSA and VRE decreased gradually. The cities with the highest MRSA and VRE detection rates tended to be adjacent; for example, the neighbouring cities Hangzhou and Quzhou had simultaneously high rates of MRSA and VRE infection. Patients from IIIA hospital who were older than 75 years and in the intensive care unit (ICU) were most at risk. No vancomycin-resistant isolate was found in MRSA. Resistance of E. faecalis and E. faecium to vancomycin and linezolid decreased slightly and then maintained a low level.ConclusionsThe detection rates of MRSA and VRE stayed at moderate and low levels during the three year period of this study, while local dissemination was found in MRSA and VRE isolates. Sustained surveillance is necessary to prevent the spread or clonal dissemination of drug-resistant strains in Zhejiang China.