Emergence of Vancomycin-Resistant Enterococci at a University Hospital in Taiwan: Persistence of Multiple Species and Multiple Clones

1999 ◽  
Vol 20 (12) ◽  
pp. 828-833 ◽  
Author(s):  
Po-Ren Hsueh ◽  
Lee-Jene Teng ◽  
Hui-Ju Pan ◽  
Yu-Chi Chen ◽  
Li-Hua Wang ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Tertiary Care ◽  
Perianal Abscess ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
The Other ◽  
University Hospital ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Multiple Species

AbstractObjectives:To describe the epidemiology of vancomycin-resistant enterococci (VRE) in a university hospital in Taipei, Taiwan.Design:Retrospective review over a 27-month period, from March 1996 to May 1998.Setting:A tertiary-care teaching hospital in Taiwan.Participants:Patients with VRE isolated from any body site.Methods:Patients were identified through hospital microbiology and infection control records. Patient charts were reviewed for clinical and epidemiology data, including age, gender, previous hospital admissions, underlying diseases, types of infection, and recent antibiotic use. VRE isolates were characterized by their typical biochemical reactions, cellular fatty acid profiles, and the presence ofvangenes. Antibiotypes using the E-test and randomly amplified polymorphic DNA (RAPD) patterns of these isolates were used to determine the clonality.Results:Twenty-five isolates of VRE recovered from 12 patients were identified. One patient with a perianal abscess had 12 isolates of VRE (4Enterococcus faecalis, 7Enterococcus faecium, and 1Enterococcus casseliflavus) recovered from perianal lesions. Among 3 patients who were hospitalized in the same room, 1 had a community-acquired cellulitis over the left leg caused byE faecalis, and the other 2 patients both had anal colonization with 2 isolates ofE faecalis. The other 8 patients had 1E faecalisisolate each from various clinical specimens. All isolates possessed vanA resistance phenotype andvanAgenes. Different antibiotypes and RAPD patterns of the isolates from different patients excluded the possibility of nosocomial spread at the hospital.Conclusions:Multiple species of VRE (E faecalis, E faecium, andE casseliflavus) and multiple clones ofE faeciumcould colonize or infect hospitalized patients. In addition, clones of VRE can persist long-term in patients' lower gastrointestinal tracts. These results extend our knowledge of the coexistence and the persistence of multiple species and multiple clones of VRE in hospitalized patients.

Recovery of Both Vancomycin-Resistant Enterococci and Methicillin-ResistantStaphylococcus aureusFrom Culture of a Single Clinical Specimen From Colonized or Infected Patients

2009 ◽  
Vol 30 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Sang Hoon Han ◽  
Bum Sik Chin ◽  
Han Sung Lee ◽  
Su Jin Jeong ◽  
Hee Kyung Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Multivariate Logistic Regression Analysis ◽  
University Hospital ◽  
Cell Contact ◽  
Patient Risk ◽  
Clinical Specimens ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Objective.To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistantStaphylococcus aureus(MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.Design.A retrospective cohort and case-control study.Setting.A tertiary care university hospital and referral center in Seoul, Korea.Methods.We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.Results.The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00;P= .012), urinary catheterization (OR, 3.36;P= .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03;P< .001).Conclusion.We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer ofvanA,close observation and surveillance for vancomycin-resistantS. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

Impact of the inpatient infectious disease consultations at a tertiary care university hospital

2019 ◽  
Author(s):  
Rami Waked ◽  
Danielle Jaafar ◽  
Marie Chedid ◽  
Gebrael Saliba ◽  
Elie Haddad ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Therapeutic Approaches ◽  
Infectious Diseases Consultation ◽  
Disease Specialist

Abstract The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting.METHODS This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit (changing the type, dose or range of the antibiotic when applicable, modifying the duration of antibiotic use), whenever the antibiotic usage was switched to a mono or bi-therapy.RESULTS The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6% of cases and Quinolones discontinuation accounted for 22.7% of cases.CONCLUSION Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients.

scholarly journals Utility of bile esculin azide agar for screening of stool samples for vancomycin resistant enterococci from patients with gut colonization

2021 ◽  
Vol 9 (12) ◽  
pp. 3633
Author(s):  
Deepa Pramod Devhare ◽  
Sae Satish Pol ◽  
Varsha Pendse
Keyword(s):  
Drug Resistance ◽  
Tertiary Care ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Test Protocol ◽  
Gut Colonization ◽  
Vancomycin Resistant Enterococci ◽  
Agar Dilution ◽  
Stool Samples ◽  
Vancomycin Resistant

Background: Due to increased prevalence of vancomycin resistant enterococci (VRE) in hospital settings as an important nosocomial pathogen, microbiology laboratories should be prepared with test protocol for prompt detection and reporting of these resistant organisms. This helps in appropriate treatment of patients without delay and implementation of infection control measures in order to prevent spread of such infections. With this background present study was conducted to demonstrate utility of bile esculin azide agar with vancomycin (BEAV) for screening of enterococci for vancomycin drug resistance.Methods: Over a period of one year 200 stool samples were collected from hospitalized patients in a tertiary care hospital. Samples were inoculated on bile esculin azide agar with vancomycin (6ug/ml) to screen for vancomycin drug resistance in enterococci isolated from stool samples. Vancomycin drug resistance was confirmed by agar dilution method.Results: Out of 200 stool samples collected from hospitalized patients, 13 (6.5%) samples showed growth on bile esculin azide agar with vancomycin (6 µg/ml). Of these 13 isolates, 12 (92.3%) isolates were confirmed as VRE by agar dilution method and demonstrated minimum inhibitory concentration (MIC) of ≥32 µg/ml and all 12 isolates were identified as E. faecium. One (7.7%) isolate grown on BEAV was identified as E. gallinarum and showed MIC value of 8 µg/ml.Conclusions: Present study recommends use of bile esculin azide agar with vancomycin (6 µg/ml) as a screening medium for isolation of VRE from stool samples which usually carries mixed commensal flora of gastrointestinal tract.

Efficacy of Infection Control Strategies to Reduce Transmission of Vancomycin-Resistant Enterococci in a Tertiary Care Hospital in Korea: A 4-Year Follow-Up Study

2007 ◽  
Vol 28 (4) ◽  
pp. 493-495 ◽  
Author(s):  
Sung Won YoonChang ◽  
Kyong Ran Peck ◽  
Og Son Kim ◽  
Jang Ho Lee ◽  
Nam Yong Lee ◽  
...  
Keyword(s):  
Infection Control ◽  
Control Strategies ◽  
Tertiary Care ◽  
University Hospital ◽  
Care Hospital ◽  
Contact Precautions ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Hospital Contact

To determine the effectiveness of infection control strategies to reduce transmission of vancomycin-resistant enterococci (VRE), a cohort study was performed in a university hospital. Contact precautions alone were not effective in reducing transmission of VRE. Strict isolation of affected patients in private rooms, in addition to use of contact precautions, showed a significantly improved reduction in the transmission of VRE.

Prevalence of Vancomycin Resistant Enterococci in Various Clinical Specimens in Tertiary Care Hospital in North Delhi

2012 ◽  
Vol 3 (3) ◽  
pp. 141-144
Author(s):  
Swati Chaudhary ◽  
◽  
Swastika Aggarwal ◽  
Pawan Kumar ◽  
SK Aggarwal SK Aggarwal ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Clinical Specimens ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

scholarly journals A Japanese traditional medicine Hochuekkito promotes negative conversion of vancomycin-resistant Enterococci

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Junko Kohno ◽  
Tsuyoshi Kawamura ◽  
Akiko Kikuchi ◽  
Tetsuya Akaishi ◽  
Shin Takayama ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Tertiary Care ◽  
Albumin Level ◽  
Kampo Medicine ◽  
Care Hospital ◽  
Intestinal Immunity ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Japanese Traditional Medicine ◽  
Negative Conversion

AbstractVancomycin-resistant enterococci (VRE) are prominent causes of nosocomial infections. Japanese traditional (Kampo) medicine promotes intestinal immunity and protects against bacterial infections. We assessed potential differences in the clinical course of VRE-positive patients, based on their characteristics and treatment with Kampo medicines. This retrospective observational study collected data from VRE-positive patients from August 2018 to July 2019 at a tertiary-care hospital in Japan. The data of 122 consecutive VRE-positive inpatients were analyzed. Sixty-nine patients were treated with probiotics, among whom, 18 were further treated with Kampo medicines. Twenty-six of the 122 patients subsequently died. In univariate analyses, subsequent VRE negative conversion significantly reduced the mortality of VRE-detected patients (p = .0003). Administration of probiotics (p = .0065) and Kampo medicines with probiotics (p = .0002), especially of the Kampo medicine hochuekkito (p = .0014), and a higher serum albumin level positively contributed to the subsequent VRE negative conversion. Multivariate analyses demonstrated that Kampo medicines and body mass index contributed to VRE negative conversion. Hochuekkito shortened the time needed for VRE negative conversion (p = 0.0485). Administration of Kampo medicines, especially of hochuekkito, in addition to probiotics in VRE patients may promote VRE negative conversion.

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