scholarly journals Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-ResistantEnterococcus faeciumat a Major Australian Teaching Hospital

2004 ◽  
Vol 25 (5) ◽  
pp. 384-390 ◽  
Author(s):  
Keryn J. Christiansen ◽  
Patricia A. Tibbett ◽  
William Beresford ◽  
John W. Pearman ◽  
Rosie C. Lee ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Care Facility ◽  
Control Measures ◽  
Epidemic Strain ◽  
Single Strain ◽  
Large Outbreak ◽  
Vancomycin Resistant ◽  
Executive Group ◽  
Group 2 ◽  
Widespread Dissemination

AbstractObjective:To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.Interventions:Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistantEnterococcus faeciumdespite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection ofvanA andvanBresistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).Results:A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistantE. faecium.Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).Conclusion:Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.

First Outbreak of Colonization and Infection With Vancomycin-ResistantEnterococcus faeciumin a Tertiary Care Hospital in Singapore

2006 ◽  
Vol 27 (9) ◽  
pp. 991-993 ◽  
Author(s):  
Maciej Piotr Chlebicki ◽  
Moi Lin Ling ◽  
Tse Hsien Koh ◽  
Li Yang Hsu ◽  
Ban Hock Tan ◽  
...  
Keyword(s):  
Infection Control ◽  
Enterococcus Faecium ◽  
Public Hospital ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Control Measures ◽  
Care Hospital ◽  
Infection Control Measures ◽  
Vancomycin Resistant

We report the first outbreak of vancomycin-resistantEnterococcus faeciumcolonization and infection among inpatients in the hematology ward of an acute tertiary care public hospital in Singapore. Two cases of bacteremia and 4 cases of gastrointestinal carriage were uncovered before implementation of strict infection control measures resulted in control of the outbreak.

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.

Control of Transmission of Vancomycin-Resistant Enterococcus faecium in a Long-Term–Care Facility

1999 ◽  
Vol 20 (05) ◽  
pp. 312-317 ◽  
Author(s):  
Maxine Armstrong-Evans ◽  
Margaret Litt ◽  
Margaret A. McArthur ◽  
Barbara Willey ◽  
Darlene Cann ◽  
...  
Keyword(s):  
Enterococcus Faecium ◽  
Long Term Care ◽  
Care Facility ◽  
Control Measures ◽  
Term Care ◽  
Long Term Care Facility ◽  
Rectal Swabs ◽  
Vancomycin Resistant ◽  
And Control

AbstractObjectives:To describe the investigation and control of transmission of vancomycin-resistant enterococci (VRE) in a residential long-term-care (LTC) setting.Outbreak Investigation:A strain of vancomycin-resistantEnterococcus faeciumnot previously isolated in Ontario colonized five residents of a 254-bed LTC facility in Toronto. The index case was identified when VRE was isolated from a urine culture taken after admission to a local hospital. Screening of rectal swabs from all 235 residents identified four others who were colonized with the same strain ofE faecium.Control Measures:Colonized residents were cohorted. VRE precautions were established as follows: gown and gloves for resident contact, restriction of contact between colonized and noncolonized residents, no sharing of personal equipment, and daily double-cleaning of residents' rooms and wheelchairs.Outcome:Two colonized residents died of causes unrelated to VRE. Although bacitracin therapy (75,000 units four times a day X 14 days) failed to eradicate carriage in two of three surviving residents, both cleared their carriage within 7 weeks. Repeat rectal swabs from 224 residents (91%) 2 months after isolation precautions were discontinued and from 125 residents (51%) 9 months later identified no new cases. Total cost of investigation and control was $12,061 (Canadian).Conclusion:VRE may be transmitted in LTC facilities, and colonized LTC residents could become important VRE reservoirs. Control of VRE transmission in LTC facilities can be achieved even with limited resources.

scholarly journals Emergence of Vancomycin Resistant Staphylococcus aureus during Hospital Admission at a Tertiary Care Hospital in Bangladesh

2017 ◽  
Vol 3 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Shahana Khanam ◽  
Jalaluddin Ashraful Haq ◽  
SM Shamsuzzaman ◽  
Md Motlabur Rahman ◽  
Kazi Zulfiquer Mamun
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Control Measures ◽  
Dilution Method ◽  
Agar Dilution Method ◽  
Care Hospital ◽  
Medical College ◽  
Nasal Swab Sample ◽  
Vancomycin Resistant

Background: Glycopeptides such as vancomycin are frequently the choice of antibiotics for the treatment of infections caused by methicillin resistant Staphylococcus aureus (MRSA). For the last 7 years incidence of vancomycin intermediate S. aureus and vancomycin resistant S. aureus (VISA and VRSA respectively) has been increasing in various parts of the world.Objective: The present study was carried out to find out the presence of VISA and VRSA among isolated MRSA strains.Methodology: This cross sectional study was carried out in the Department of Microbiology in Dhaka medical college during period of January 2010 to December 2011. All S. aureus isolates were screened to detect methicillin resistance and then all MRSA isolates were subjected for MIC testing against vancomycin and oxacillin by agar dilution method, disc diffusion testing and PCR for mecA and pvl genes detection.Result: A total 112 S. aureus were isolated from 500 nasal swab sample collected from adult patients who were admitted in various departments and wards in Dhaka Medical College Hospital. Among 38 MRSA strains out of 112 Staph aureus isolates 3(7.89%) strains were resistance to vancomycin of which 2(5.26%) strains had MIC > 256 mg/mL and one strain had MIC 256mg/mL. All vancomycin resistance strains had MIC of oxacillin > 256 mg/mL. All isolates possess mec-A gene.Conclusion: The present study reveals that emergence of VRSA upon admission at a tertiary care of hospital in Bangladesh. Continuous efforts should be made to prevent the spread and the emergence of VRSA by early detection of the resistant strains and using the proper infection control measures in the hospital setting.Bangladesh Journal of Infectious Diseases 2016;3(1):11-16

Effects of three methods of femoral site immobilization on bleeding and comfort after coronary angiogram

1995 ◽  
Vol 4 (2) ◽  
pp. 143-148 ◽  
Author(s):  
E Hogan-Miller ◽  
D Rustad ◽  
S Sendelbach ◽  
I Goldenberg
Keyword(s):  
Coronary Angiography ◽  
Tertiary Care ◽  
Care Facility ◽  
Patient Comfort ◽  
Verbal Instruction ◽  
Femoral Site ◽  
Tertiary Care Facility ◽  
Group 3 ◽  
Group 2 ◽  
Ordinal Level

BACKGROUND: Postangiogram femoral site care varies by institution and practitioner. The literature is unclear about which intervention provides the best hemostasis and patient comfort. OBJECTIVE: To investigate which method of femoral site immobilization results in less bleeding and more comfort after coronary angiography. METHODS: Three hundred inpatients and outpatients undergoing coronary angiography in a large, metropolitan, tertiary care facility were assigned randomly to three types of femoral site immobilization. A three-group experimental design was used in this intervention study. Patients were on bedrest and received one of the following interventions to the affected (site of puncture) leg for 6 hours: group 1 had a sandbag applied to the femoral site, group 2 had a sheet over the affected leg and tucked under the mattress, and group 3 had verbal instruction to keep the leg straight and still. An ordinal level hemostasis scale was developed, with descriptors based on the extent of intervention necessary, ranging from 1 = none to 5 = surgical. A 17-item, Likert-type scale was used. RESULTS: The verbal instruction group experienced significantly more bleeding than the sandbag group. There was no difference in bleeding or comfort between the sandbag and sheet-tuck groups. CONCLUSIONS: Our results indicated that sheet-tuck immobilization of the affected leg provides the same degree of hemostasis to the femoral site after coronary angiography as the sandbag.

Occurrence of Co-colonization or Co-Infection with Vancomycin-Resistant Enterococci and Methicillin-ResistantStaphylococcus aureusin a Medical Intensive Care Unit

2004 ◽  
Vol 25 (2) ◽  
pp. 99-104 ◽  
Author(s):  
David K. Warren ◽  
Anand Nitin ◽  
Cheri Hill ◽  
Victoria J. Fraser ◽  
Marin H. Kollef
Keyword(s):  
Intensive Care ◽  
Soft Tissue ◽  
Multiple Logistic Regression Analysis ◽  
Care Facility ◽  
Positive Culture ◽  
Control Measures ◽  
Medical Patients ◽  
Term Care ◽  
Recent Emergence ◽  
Vancomycin Resistant

AbstractObjective:To determine the occurrence of co-colonization or co-infection with VRE and MRSA among medical patients requiring intensive care.Design:Prospective, single-center, observational study.Setting:A 19-bed medical ICU in an urban teaching hospital.Patients:Adult patients requiring at least 48 hours of intensive care and having at least one culture performed for microbiologie evaluation.Results:Eight hundred seventy-eight consecutive patients were evaluated. Of these patients, 402 (45.8%) did not have microbiologie evidence of colonization or infection with either VRE or MRSA 355 (40.4%) were colonized or infected with VRE, 38 (4.3%) were colonized or infected with MRSA, and 83 (9.5%) had co-colonization or co-infection with VRE and MRSA. Multiple logistic regression analysis demonstrated that increasing age, hospitalization during the preceding 6 months, and admission to a long-term-care facility were independently associated with colonization or infection due to VRE and co-colonization or co-infection with VRE and MRSA. The distributions of positive culture sites for VRE (stool, 86.7%; blood, 6.5%; urine, 4.8%; soft tissue or wound, 2.0%) and for MRSA (respiratory secretions, 34.1%; blood, 32.6%; urine, 17.1%; soft tissue or wound, 16.2%) were statistically different (P< .001).Conclusions:Co-colonization or co-infection with VRE and MRSA is common among medical patients requiring intensive care. The recent emergence of vancomycin-resistantStaphylococcus aureusand the presence of a patient population co-colonized or co-infected with VRE and MRSA support the need for aggressive infection control measures in the ICU.

Carriage of Methicillin-ResistantStaphylococcus aureusAmong Hospital Employees: Prevalence, Duration, and Transmission to Households

2004 ◽  
Vol 25 (2) ◽  
pp. 114-120 ◽  
Author(s):  
Matthieu Eveillard ◽  
Yolaine Martin ◽  
Nadia Hidri ◽  
Yves Boussougant ◽  
Marie-Laure Joly-Guillou
Keyword(s):  
Tertiary Care ◽  
Healthcare Providers ◽  
Care Facility ◽  
Control Measures ◽  
Prevalence Survey ◽  
Term Care ◽  
Long Term Care Facility ◽  
Hospital Employees ◽  
Medical Wards ◽  
Few Data

AbstractObjective:To assess the prevalence and duration of methicillin-resistantStaphylococcus aureus(MRSA) carriage among hospital employees and transmission to their households.Design:A point-prevalence survey of MRSA carriage (nasal swabbing) of staff and patients throughout the hospital; a prevalence survey of MRSA carriage in 2 medical wards, with carriers observed to estimate carriage duration; and evaluation of transmission to MRSA-positive workers' families. All MRSA isolates were analyzed by pulsed-field gel electrophoresis. During the study, no MRSA outbreak was detected among hospitalized patients.Setting:A 600-bed, public tertiary-care teaching hospital near Paris.Results:Sixty MRSA carriers were identified among 965 healthcare providers (prevalence, 6.2%; CL,, 4.7%-7.7%). Prevalence was higher in staff from clinical wards than from elsewhere (9.0% vs 2.1%;P< .0001). Identity of isolates from employees and patients varied from 25% in medical wards to 100% in the long-term-care facility. MRSA carriage was identified in 14 employees from 2 medical wards (prevalence, 19.4%; CI95, 10.3%-28.5%). Prevalence depended on the length of service in these wards. Transmission to households was investigated in 10 MRSA-positive workers' families and was found in 4. All isolates from each family were identical.Conclusions:Few data are available concerning the prevalence of MRSA carriers among hospital employees in the absence of an outbreak among patients. MRSA transmission between patients and employees likely depends on the frequency and duration of exposure to MRSA-positive patients and infection control measures employed. Frequent transmission of MRSA from colonized healthcare workers to their households was documented.

scholarly journals Genomic surveillance of vancomycin-resistant Enterococcus faecium reveals spread of a linear plasmid conferring a nutrient utilization advantage

2021 ◽  
Author(s):  
Mathilde Boumasmoud ◽  
Vanina Dengler Haunreiter ◽  
Tiziano A. Schweizer ◽  
Lilly Meyer ◽  
Bhavya Chakrakodi ◽  
...  
Keyword(s):  
Enterococcus Faecium ◽  
Evolutionary Dynamics ◽  
Tertiary Care ◽  
Nutrient Utilization ◽  
Control Measures ◽  
Phylogenomic Analysis ◽  
Vancomycin Resistant Enterococcus ◽  
Transmission Networks ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Healthcare-associated outbreaks of vancomycin-resistant Enterococcus faecium (VREfm) are a worldwide problem with increasing prevalence. The genomic plasticity of this hospital-adapted pathogen contributes to its efficient spread despite infection control measures. Here, we aimed to identify the genomic and phenotypic determinants of healthcare-associated transmission of VREfm. We assessed the VREfm transmission networks at the tertiary-care University Hospital of Zurich (USZ) between October 2014 and February 2018 and investigated microevolutionary dynamics of this pathogen. We performed whole-genome sequencing for the 69 VREfm isolates collected during this timeframe and assessed the population structure and variability of the vancomycin resistance transposon. Phylogenomic analysis allowed us to reconstruct transmission networks and to unveil external or indirect transmission networks, not detectable by traditional surveillance. Notably, it unveiled a persistent clone, sampled 31 times over a 29-month period. Exploring the evolutionary dynamics of this clone and characterizing the phenotypic consequences revealed the spread of a variant with decreased daptomycin susceptibility and the acquired ability to utilize N acetyl galactosamine (GalNAc), one of the primary constituents of the human gut mucins. This nutrient utilization advantage was conferred by a novel plasmid, termed pELF_USZ, which exhibited a linear topology. This plasmid, which was harbored by two distinct clones, was transferable by conjugation. Overall, this work provides an example of the potential of the integration of epidemiological, functional genomic and evolutionary perspectives to understand adaptation strategies contributing to the successful spread of VREfm.

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