Outbreaks of Vancomycin-Resistant Enterococci in Hospital Settings: A Systematic Review and Calculation of the Basic Reproductive Number

2015 ◽  
Vol 37 (3) ◽  
pp. 289-294 ◽  
Author(s):  
Laetitia Satilmis ◽  
Philippe Vanhems ◽  
Thomas Bénet
Keyword(s):  
Descriptive Analysis ◽  
Reproductive Rate ◽  
Control Measures ◽  
Basic Reproductive Number ◽  
Reproductive Number ◽  
Surveillance Program ◽  
Vancomycin Resistant Enterococci ◽  
The Mean ◽  
Vancomycin Resistant ◽  
Index Cases

BACKGROUNDVancomycin-resistant enterococci (VRE) have spread worldwide.OBJECTIVETo systematically review VRE outbreaks and estimate the pooled basic reproductive rate (R0) of VRE.METHODSEligible studies criteria were (1) published within 10 years, (2) report outbreak details, (3) involve 1 center, (4) estimate epidemic duration, and (5) concern adults. Descriptive analysis included number of index cases, secondary cases, and screened patients; infection control measures; and definition of contact patients. R0 was estimated by the equation R0=(ln2) D/td+1, with D as the generation time and td as the doubling time.RESULTSThirteen VRE outbreaks were retained from 180 articles and, among them, 10 were kept for R0 calculation. The mean (range) number of index cases was 2.3 (1–8) and the mean (range) number of secondary cases was 15 (3–56). The mean (range) number of screened patients was 174 (32–509), with pooled VRE prevalence of 5.4% (95% CI, 4.5%–6.3%). Contact precautions were reported in 12 studies (92%), wards were closed in 7 (54%), with cohorting in 6 (46%). Two major screening policies were implemented: (1) a surveillance program in the unit or hospital (7 studies [54%]) and (2) screening of selected contact patients (6 studies [46%]). The pooled R0 of VRE was 1.32 (interquartile range, 1.03–1.46).CONCLUSIONWe discerned considerable heterogeneity in screening policies during VRE outbreaks. Pooled R0 was higher than 1, confirming the epidemic nature of VRE.Infect. Control Hosp. Epidemiol. 2016;37(3):289–394

scholarly journals Vancomycin-resistant enterococci colonization and bacteremia in patients with hematological malignancies

2014 ◽  
Vol 8 (09) ◽  
pp. 1113-1118 ◽  
Author(s):  
Habip Gedik ◽  
Taner Yıldırmak ◽  
Funda Şimşek ◽  
Arzu Kantürk ◽  
Deniz Arıca ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Tertiary Hospital ◽  
Control Measures ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Study Results ◽  
Hematological Cancers ◽  
Training And Research ◽  
The Mean ◽  
Vancomycin Resistant

Introduction: We retrospectively evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRE-related infections in patients with hematological malignancies. Methodology: All patients in the hematology department of the Ministry of Health Okmeydanı Training and Research Hospital, an 800-bed tertiary hospital in İstanbul, Turkey, older than 14 years of age and who developed febrile neutropenia during chemotherapy for hematological cancers between November 2010 and November 2012 were evaluated in this retrospective observational study. Results: A total of 282 neutropenic episodes in 126 patients who met the inclusion criteria were analyzed. The mean patient age was 51.73 ± 14.4 years (range: 17–82 years), and 66 cases occurred in male patients. The mean Multinational Association for Supportive Care in Cancer score of patients with hematological malignancies was 17.18 ± 8.27. Fifty (39.68%) patients were colonized with VRE, and the mean number of VRE colonization days per patient was 34.27 ± 13.12 days. Only two patients developed VRE bacteremia: a male patient with non-Hodgkin’s lymphoma who survived the infection, and a female patient with acute myeloid leukemia who died from VRE bacteremia. Conclusions: Patients with hematological malignancies accompanied by VRE colonization should be expected to develop VRE- or vancomycin-sensitive enterococci-related bacteremia under certain conditions, which include the development of severe mucositis, invasive procedures, and the use of intensive broad-spectrum antibiotics, even if infection control measures are implemented properly.

Control of Vancomycin-Resistant Enterococci at a Community Hospital: Efficacy of Patient and Staff Cohorting

1999 ◽  
Vol 20 (2) ◽  
pp. 106-109 ◽  
Author(s):  
Elise M. Jochimsen ◽  
Laurie Fish ◽  
Kelly Manning ◽  
Sally Young ◽  
Daniel A. Singer ◽  
...  
Keyword(s):  
Community Hospital ◽  
Point Prevalence ◽  
Control Measures ◽  
Prevalence Survey ◽  
Infection Control Measures ◽  
Contact Isolation ◽  
Point Prevalence Survey ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
The Impact

AbstractObjective:To evaluate the efficacy of patient and staff cohorting to control vancomycin-resistant enterococci (VRE) at an Indianapolis community hospital.Design:To interrupt transmission of VRE, a VRE point-prevalence survey of hospital inpatients was conducted, and VRE-infected or -colonized patients were cohorted on a single ward with dedicated nursing staff and patient-care equipment. To assess the impact of the intervention, staff compliance with contact isolation procedures was observed, and the VRE point-prevalence survey was repeated 2 months after the cohort ward was established.Results:Following the establishment of the cohort ward, VRE prevalence among all hospitalized inpatients decreased from 8.1% to 4.7% (25 positive cultures among 310 patients compared to 13 positive cultures among 276 patients,P=.14); VRE prevalence among patients whose VRE status was unknown before cultures were obtained decreased from 5.9% to 0.8% (18 positive cultures among 303 patients compared to 2 positive cultures among 262 patients,P=.002); and observed staff-patient interactions compliant with published isolation recommendations increased (5 [22%] of 23 interactions compared to 36 [88%] of 41 interactions,P<.0001).Conclusions:Our data suggest that, in hospitals with endemic VRE or continued VRE transmission despite implementation of contact isolation measures, establishing a VRE cohort ward may be a practical and effective method to improve compliance with infection control measures and thereby to control epidemic or endemic VRE transmission.

scholarly journals Viral Dynamics of Acute HIV-1 Infection

1999 ◽  
Vol 190 (6) ◽  
pp. 841-850 ◽  
Author(s):  
Susan J. Little ◽  
Angela R. McLean ◽  
Celsa A. Spina ◽  
Douglas D. Richman ◽  
Diane V. Havlir
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Doubling Time ◽  
Basic Reproductive Number ◽  
Reproductive Number ◽  
Target Cells ◽  
Viral Dynamics ◽  
Acute Hiv Infection ◽  
Acute Hiv ◽  
The Mean

Viral dynamics were intensively investigated in eight patients with acute HIV infection to define the earliest rates of change in plasma HIV RNA before and after the start of antiretroviral therapy. We report the first estimates of the basic reproductive number (R0), the number of cells infected by the progeny of an infected cell during its lifetime when target cells are not depleted. The mean initial viral doubling time was 10 h, and the peak of viremia occurred 21 d after reported HIV exposure. The spontaneous rate of decline (α) was highly variable among individuals. The phase 1 viral decay rate (δI = 0.3/day) in subjects initiating potent antiretroviral therapy during acute HIV infection was similar to estimates from treated subjects with chronic HIV infection. The doubling time in two subjects who discontinued antiretroviral therapy was almost five times slower than during acute infection. The mean basic reproductive number (R0) of 19.3 during the logarithmic growth phase of primary HIV infection suggested that a vaccine or postexposure prophylaxis of at least 95% efficacy would be needed to extinguish productive viral infection in the absence of drug resistance or viral latency. These measurements provide a basis for comparison of vaccine and other strategies and support the validity of the simian immunodeficiency virus macaque model of acute HIV infection.

scholarly journals A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Stefanie Kampmeier ◽  
Hauke Tönnies ◽  
Carlos L. Correa-Martinez ◽  
Alexander Mellmann ◽  
Vera Schwierzeck
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Prevention ◽  
Control Measures ◽  
Whole Genome Sequence ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Abstract Background Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. Methods Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). Results WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. Conclusions Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.

scholarly journals Differential effects of intervention timing on COVID-19 spread in the United States

2020 ◽  
Vol 6 (49) ◽  
pp. eabd6370 ◽  
Author(s):  
Sen Pei ◽  
Sasikiran Kandula ◽  
Jeffrey Shaman
Keyword(s):  
United States ◽  
Disease Transmission ◽  
Human Mobility ◽  
The United States ◽  
Control Measures ◽  
Basic Reproductive Number ◽  
Transmission Model ◽  
Reproductive Number ◽  
Mobility Data ◽  
Nonpharmaceutical Interventions

Assessing the effects of early nonpharmaceutical interventions on coronavirus disease 2019 (COVID-19) spread is crucial for understanding and planning future control measures to combat the pandemic. We use observations of reported infections and deaths, human mobility data, and a metapopulation transmission model to quantify changes in disease transmission rates in U.S. counties from 15 March to 3 May 2020. We find that marked, asynchronous reductions of the basic reproductive number occurred throughout the United States in association with social distancing and other control measures. Counterfactual simulations indicate that, had these same measures been implemented 1 to 2 weeks earlier, substantial cases and deaths could have been averted and that delayed responses to future increased incidence will facilitate a stronger rebound of infections and death. Our findings underscore the importance of early intervention and aggressive control in combatting the COVID-19 pandemic.

Impact of Surveillance for Vancomycin-Resistant Enterococci on Controlling a Bloodstream Outbreak Among Patients With Hematologic Malignancy

2004 ◽  
Vol 25 (5) ◽  
pp. 391-394 ◽  
Author(s):  
Ray Hachem ◽  
Linda Graviss ◽  
Hend Hanna ◽  
Rebecca Arbuckle ◽  
Tanya Dvorak ◽  
...  
Keyword(s):  
Critically Ill ◽  
Hematologic Malignancy ◽  
Incidence Density ◽  
Fiscal Year ◽  
Surveillance Program ◽  
Complete Control ◽  
Vancomycin Resistant Enterococci ◽  
Surveillance Cultures ◽  
Vancomycin Resistant ◽  
The Impact

AbstractObjective:To determine the impact of stool surveillance cultures of critically ill patients on controlling vancomycin-resistant enterococci (VRE) outbreak bacteremia.Design:Stool surveillance cultures were performed on patients who had hematologic malignancy or were critically ill at the time of hospital admission to identify those colonized with VRE. Hence, contact isolation was initiated.Setting:A tertiary-care cancer center with a high prevalence of VRE.Participants:All patients with hematologic malignancy who were admitted to the hospital as well as all of those admitted to the intensive care unit were eligible.Results:Active stool surveillance cultures performed between 1997 and 2001 decreased the incidence density of VRE bacteremias eightfold while vancomycin use remained constant. In fiscal year (FY) 1997 and FY 1998, there were five and three VRE outbreak bacteremias, respectively. The outbreak clones were responsible for infection in 69% of those patients with VRE bacteremia. However, the stool surveillance program resulted in the complete control of VRE bacteremia by FY 1999 until the end of the study.Conclusion:Despite the steady use of vancomycin, the active surveillance program among high-risk patients with hematologic malignancy and those who were critically ill resulted in the complete control of VRE outbreak bacteremia at our institution.

Management of an Outbreak of Vancomycin-Resistant Enterococci in the Medical Intensive Care Unit of a Cancer Center

2001 ◽  
Vol 22 (4) ◽  
pp. 217-219 ◽  
Author(s):  
Hend Hanna ◽  
Jan Umphrey ◽  
Jeffrey Tarrand ◽  
Michelle Mendoza ◽  
Issam Raad
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Control Measures ◽  
Cancer Center ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Medical Intensive Care ◽  
Vancomycin Resistant

AbstractBetween November 1996 and February 1997, 17 episodes of vancomycin-resistant enterococci (VRE) infection or colonization (9 infections, 8 colonizations), all with the same or a similar genomic DNA pattern, were identified in the medical intensive care unit (MICU) of a tertiary-care cancer hospital. The cases were genotypically traced to a patient who was admitted to the hospital in September 1996 and who, by December 1996, had four different admissions to the MICU. Multifaceted infection control measures, including decontamination of the environment and of nondisposable equipment, halted the nosocomial transmission of VRE in the MICU.

Infection-Control Measures Reduce Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting

1999 ◽  
Vol 131 (4) ◽  
pp. 269 ◽  
Author(s):  
Marisa A. Montecalvo ◽  
William R. Jarvis ◽  
Jane Uman ◽  
David K. Shay ◽  
Coleen Petrullo ◽  
...  
Keyword(s):  
Infection Control ◽  
Control Measures ◽  
Endemic Setting ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

scholarly journals Vancomycin-Resistant Enterococci: The Value of Infection Control and Antibiotic Control Policy

2006 ◽  
Vol 17 (suppl b) ◽  
pp. 9B-12B ◽  
Author(s):  
Karl Weiss
Keyword(s):  
Health Care ◽  
Infection Control ◽  
Health Care System ◽  
Control Measures ◽  
Canadian Health Care System ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Canadian Health ◽  
Canadian Health Care ◽  
Vancomycin Resistant

Vancomycin-resistant enterococci (VRE) represent a major challenge for the Canadian health care system. The clinical significance of VRE in the Canadian health care system has increased over the past two decades, with outbreaks reported in Ontario and Quebec, although most provinces have been affected. This organism has been a substantial human and financial burden for Canadian institutions. VRE have been shown to be associated with an increased mortality, a longer hospital stay and a much higher overall cost compared with vancomycinsusceptible strains. Enterococci are now the third most important nosocomial pathogen in American intensive care units. The two most common species,Enterococcus faecalisandEnterococcus faecium, have shown remarkable adaptability in responding to antibiotics. The arrival of VRE in Canada has forced hospitals to implement stringent and costly infection control measures. A multifaceted approach, including antibiotic restriction and stringent infection control measures, is important in managing VRE prevalence in Canadian institutions.

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