Skin and Environmental Contamination With Vancomycin-Resistant Enterococci in Patients Receiving Oral Metronidazole or Oral Vancomycin Treatment forClostridium difficile–Associated Disease

2009 ◽  
Vol 30 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Ajay K. Sethi ◽  
Wafa N. Al-Nassir ◽  
Michelle M. Nerandzic ◽  
Curtis J. Donskey
Keyword(s):  
Fecal Incontinence ◽  
Environmental Contamination ◽  
Prospective Observational Study ◽  
Medical Center ◽  
Veterans Affairs ◽  
Vancomycin Resistant Enterococci ◽  
Before And After ◽  
Vancomycin Resistant ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

Background.Oral metronidazole has been recommended for treatment of mild-to-moderateClostridium difficile–associated disease (CDAD), in part because of concern that use of vancomycin may be more likely to promote colonization and transmission of vancomycin-resistant enterococci (VRE). The objective of our study was to compare the frequency of skin and environmental VRE contamination associated with metronidazole treatment for CDAD with such frequency associated with vancomycin treatment for CDAD.Design.Prospective, observational study. This study was performed at the Cleveland Veterans Affairs Medical Center (Cleveland, OH). For patients with CDAD who had concurrent VRE colonization, stool, skin, and environmental samples were cultured for VRE before, during, and up to 3 weeks after therapy with metronidazole or vancomycin. The proportions of skin and environmental contamination were compared before and after resolution of diarrhea and during treatment with metronidazole or vancomycin.Results.Of the 34 patients, 17 were treated with vancomycin and 17 were treated with metronidazole. The proportion of environmental cultures that were positive for VRE was significantly higher during resolution of diarrhea than it was after resolution of diarrhea (38% vs 28%;P= .025), whereas the proportion of skin cultures positive was not different during and after resolution of diarrhea (78% vs 71%;P= .60). There were no differences between patients who received metronidazole and patients who received vancomycin in the proportions of skin culture results (73% vs 77%;P= .80) or environmental culture results (37% vs 32%;P= .359) that were positive for VRE. Eleven patients (32%) had chronic fecal incontinence, and 28 (82%) had incontinence at least once during their CDAD episode.Conclusions.In VRE-colonized patients with CDAD who experienced frequent fecal incontinence, skin and environmental VRE contamination was common during and after resolution of diarrhea. The frequency of VRE contamination was similar between patients treated with metronidazole and patients treated with vancomycin.

scholarly journals Both Oral Metronidazole and Oral Vancomycin Promote Persistent Overgrowth of Vancomycin-Resistant Enterococci during Treatment of Clostridium difficile-Associated Disease

2008 ◽  
Vol 52 (7) ◽  
pp. 2403-2406 ◽  
Author(s):  
Wafa N. Al-Nassir ◽  
Ajay K. Sethi ◽  
Yuejin Li ◽  
Michael J. Pultz ◽  
Michelle M. Riggs ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Prospective Observational Study ◽  
Oral Vancomycin ◽  
The Past ◽  
Vancomycin Resistant Enterococci ◽  
Stool Samples ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

ABSTRACT For treatment of mild to moderate Clostridium difficile-associated disease (CDAD), oral metronidazole has been recommended as the preferred agent, in part due to concern that vancomycin may be more likely to promote colonization by vancomycin-resistant enterococci (VRE). We performed a prospective observational study to examine the effects of oral metronidazole or vancomycin treatment of CDAD on acquisition and concentration of VRE stool colonization. Before, during, and after 90 courses of CDAD therapy, stool samples were cultured for VRE, and the concentrations were quantified. Eighty-seven subjects (97%) had received antibiotics within the past month. For 56 treatment courses in which preexisting VRE colonization was present, metronidazole (n = 37 courses) and vancomycin (n = 19 courses), each promoted persistent VRE overgrowth during therapy, and the concentration decreased significantly in both groups by ∼2 weeks after completion of treatment (P <0.049). For 34 treatment courses in which baseline cultures were negative for VRE, new detection of VRE stool colonization occurred during 3 (14%) of the 22 courses of metronidazole and 1 (8%) of the 12 courses of vancomycin (P = 1.0). These results demonstrate that both oral metronidazole and oral vancomycin promote the overgrowth of VRE during treatment of CDAD. New CDAD treatments are needed that are less likely to disrupt the intestinal microflora and promote overgrowth of healthcare-associated pathogens.

Lack of Increased Colonization with Vancomycin-Resistant Enterococci during Preferential Use of Vancomycin for Treatment during an Outbreak of Healthcare-Associated Clostridium difficile Infection

2010 ◽  
Vol 31 (7) ◽  
pp. 710-715 ◽  
Author(s):  
Mark Miller ◽  
Lisa Bernard ◽  
Melissa Thompson ◽  
Daniel Grima ◽  
Jocelyne Pepin
Keyword(s):  
Clostridium Difficile ◽  
Oral Vancomycin ◽  
Outbreak Period ◽  
Vancomycin Resistant Enterococci ◽  
Period 2 ◽  
Jewish General Hospital ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

Objective.To assess whether use of oral vancomycin for treatment during an outbreak of Clostridium difficile infection (CDI) was associated with increased rates of colonization with vancomycin-resistant enterococci (VRE)..Design.A retrospective analysis of hospital databases.Setting.The Jewish General Hospital in Montreal, Quebec, Canada.Methods.We collected data regarding VRE colonization and CDI from November 1, 2000, through September 30, 2007, during which policies of preferential oral metronidazole or vancomycin treatment were implemented to control an outbreak of CDI. Four periods were considered: period 1, the preoutbreak period when metronidazole was used; period 2, the CDI outbreak period when metronidazole was used; period 3, the postoutbreak period when vancomycin was used; and period 4, the postoutbreak period when metronidazole was used.Results.A total of 2,412 cases of CDI and 425 cases of VRE colonization were identified. The rate of CDI increased significantly during period 2 and decreased to preoutbreak levels during period 3. The rate of VRE also increased during period 2 and decreased during the first 18 months of period 3. A clonal outbreak of cases of VRE (VanA) colonization was observed toward the end of period 3 and into period 4. Excluding the period of the clonal outbreak, there was a strong correlation between the number of cases of CDI and VRE colonization (r = 0.736; P = .001) and a negative association between VRE colonization and vancomycin use (r = —0.765; P = .04).Conclusions.Increased vancomycin use was not associated with an increase in VRE colonization over a 2-year period. Restriction of vancomycin use during CDI outbreaks because of the fear of increasing VRE colonization may not be warranted.

scholarly journals Vancomycin-Resistant Enterococci and Extended-Spectrum β-Lactamase-Producing Bacterial Colonization of the Cervix after Emergency Cerclage: Is It Safe?

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 933
Author(s):  
Won-Kyu Jang ◽  
Jin-Gon Bae
Keyword(s):  
Early Onset ◽  
Neonatal Death ◽  
Medical Center ◽  
Bacterial Colonization ◽  
Control Group ◽  
Vancomycin Resistant Enterococci ◽  
Extended Spectrum ◽  
Early Onset Sepsis ◽  
Cervical Surgery ◽  
Vancomycin Resistant

Antimicrobial resistance is currently becoming a global threat to human health. We performed a retrospective study on patients who underwent emergency cerclage between January 2016 and December 2018 at the Dongsan Medical Center. Cervical culture was first performed before surgery to confirm that there was no infection and was repeated on days 1, 4, and 7 after surgery. A total of 85 pregnant women underwent emergency cerclage. Among them, six patients had vancomycin-resistant enterococci (VRE) colonization in the cervix after cerclage, and 23 patients developed extended-spectrum β-lactamase (ESBL)-producing bacterial colonization in the cervix. The average gestational age at delivery was lower in the VRE group. Neonatal death was also significantly higher in the VRE group. The rate of occurrence of early-onset sepsis was also higher in the VRE group, and both VRE and ESBL-producing bacterial colonization cases in which early-onset sepsis occurred resulted in neonatal death. The prognosis of cervical VRE colonization after cervical surgery was poor, whereas the prognosis of ESBL-producing bacterial colonization in the cervix did not differ significantly from that of the control group. However, careful neonatal treatment is required considering that early-onset sepsis is fatal to the newborn.

Timing and route of contamination of hospitalized patient rooms with healthcare-associated pathogens

2021 ◽  
pp. 1-6
Author(s):  
Sarah N. Redmond ◽  
Basya S. Pearlmutter ◽  
Yilen K. Ng-Wong ◽  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
...  
Keyword(s):  
Pathogen Detection ◽  
Veterans Affairs ◽  
Portable Equipment ◽  
Healthcare Facilities ◽  
Clostridioides Difficile ◽  
Bacteriophage Ms2 ◽  
Vancomycin Resistant Enterococci ◽  
Observational Cohort ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Abstract Objective: To investigate the timing and routes of contamination of the rooms of patients newly admitted to the hospital. Design: Observational cohort study and simulations of pathogen transfer. Setting: A Veterans’ Affairs hospital. Participants: Patients newly admitted to the hospital with no known carriage of healthcare-associated pathogens. Methods: Interactions between the participants and personnel or portable equipment were observed, and cultures of high-touch surfaces, floors, bedding, and patients’ socks and skin were collected for up to 4 days. Cultures were processed for Clostridioides difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Simulations were conducted with bacteriophage MS2 to assess plausibility of transfer from contaminated floors to high-touch surfaces and to assess the effectiveness of wearing slippers in reducing transfer. Results: Environmental cultures became positive for at least 1 pathogen in 10 (59%) of the 17 rooms, with cultures positive for MRSA, C. difficile, and VRE in the rooms of 10 (59%), 2 (12%), and 2 (12%) participants, respectively. For all 14 instances of pathogen detection, the initial site of recovery was the floor followed in a subset of patients by detection on sock bottoms, bedding, and high-touch surfaces. In simulations, wearing slippers over hospital socks dramatically reduced transfer of bacteriophage MS2 from the floor to hands and to high-touch surfaces. Conclusions: Floors may be an underappreciated source of pathogen dissemination in healthcare facilities. Simple interventions such as having patients wear slippers could potentially reduce the risk for transfer of pathogens from floors to hands and high-touch surfaces.

scholarly journals Nursing-Home Patient Functional and Microbiota Status Drive Environmental Contamination with Vancomycin-Resistant Enterococci

2021 ◽  
Vol 1 (S1) ◽  
pp. s68-s68
Author(s):  
Joyce Wang ◽  
Betsy Foxman ◽  
A. Krishna Rao ◽  
Lona Mody ◽  
Evan Snitkin
Keyword(s):  
Nursing Homes ◽  
Gut Microbiota ◽  
Functional Status ◽  
Environmental Contamination ◽  
Functional Dependence ◽  
Patient Factors ◽  
High Functioning ◽  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Vancomycin Resistant

Background: Patient colonization and shedding of vancomycin-resistant enterococci (VRE) is a major source of environmental contamination leading to VRE transmission in nursing homes. We hypothesize that we can inform mitigation strategies by identifying patient clinical and microbiota features associated with environmental contamination with VRE. Methods: During a 6-month period of active surveillance in 6 Michigan nursing homes, 245 patients (with 806 follow-up visits) were enrolled. Patient clinical data and swabs for VRE were collected from multiple body sites and high-touch environmental surfaces. In total, 316 perirectal swabs were collected from 137 patients for gut microbiota analysis and community status type (CST) assignment based on taxonomic composition. The associations between VRE colonization pattern, gut microbial CST, and patient factors were examined using multivariable generalized estimating equations, adjusting for patient-and facility-level clustering. We used VRE colonization patterns to group study visits: “uncolonized” (patient−/environment−); “environment-only” (patient−/environment+); “patient-only” (patient+/environment−); “both” (patient+/environment+). Results: Across all study visits, VRE colonization on patient hand and groin/perirectal area was positively correlated with VRE contamination of high-touch environmental surfaces, suggesting direct transfer of VRE between patient and environment via patient hands (Figure 1A). We next set out to identify patient factors associated with patient colonization and environmental contamination. At baseline, while patients in the “both” group had anticipated risk factors such as longer prior hospitalization and more frequent broad-spectrum antibiotic use, they were unexpectedly younger than “uncolonized” patients and had similar functional status. This last feature contrasted with the “patient-only” group, characterized by higher urinary catheter use and higher functional dependence, suggestive of lower functional dependence facilitating patient contamination of their environment. No clinical features distinguished “uncolonized” and “environment-only” patients (Table 1). Lastly, in multivariable analyses, we determined the contribution of patient functional status and gut microbiota features to environmental contamination. Low-diversity CST, characterized by reduced anaerobic taxa, was weakly associated with “patient-only” and significantly associated with “both.” Notably, high functional dependence was significantly associated with “environment-only” and “patient-only” but not “both,” indicating high-functioning patients with disrupted gut microbiota as drivers of environmental contamination (Figure 1B). Conclusions: Our findings suggest that antimicrobial exposure disrupts patient gut microbiota, a significant mediator of colonization dynamics between patients and their environment, and that high-functioning patients may be more likely to spread VRE between their body sites and high-touch environmental surfaces (Figure 2). These findings highlight both antibiotic stewardship and patient hand hygiene as important targets for interrupting transmission mediated by environmental contamination.Funding: NoDisclosures: None

scholarly journals Environmental Contamination with Vancomycin-Resistant Enterococci from Hospital Sewage in Portugal

2005 ◽  
Vol 71 (7) ◽  
pp. 4162-4162
Author(s):  
Carla Novais ◽  
Teresa M. Coque ◽  
Helena Ferreira ◽  
João Carlos Sousa ◽  
Luisa Peixe
Keyword(s):  
Environmental Contamination ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Hospital Sewage

scholarly journals A Comparison of Environmental Contamination by Patients Infected or Colonized with Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococci: A Multicenter Study

2014 ◽  
Vol 35 (7) ◽  
pp. 872-875 ◽  
Author(s):  
Lauren P. Knelson ◽  
David A. Williams ◽  
Maria F. Gergen ◽  
William A. Rutala ◽  
David J. Weber ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Multicenter Study ◽  
Environmental Contamination ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Interquartile Range ◽  
Methicillin Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Colony Forming Units ◽  
Vancomycin Resistant

A total of 1,023 environmental surfaces were sampled from 45 rooms with patients infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) before terminal room cleaning. Colonized patients had higher median total target colony-forming units (CFU) of MRSA or VRE than did infected patients (median, 25 CFU [interquartile range, 0–106 CFU] vs 0 CFU [interquartile range, 0–29 CFU]; P = .033).Infect Control Hosp Epidemiol 2014;35(7):872–875

scholarly journals Decontamination of Targeted Pathogens from Patient Rooms Using an Automated Ultraviolet-C-Emitting Device

2013 ◽  
Vol 34 (5) ◽  
pp. 466-471 ◽  
Author(s):  
Deverick J. Anderson ◽  
Maria F. Gergen ◽  
Emily Smathers ◽  
Daniel J. Sexton ◽  
Luke F. Chen ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Environmental Services ◽  
Convenience Sample ◽  
Vancomycin Resistant Enterococci ◽  
Colony Forming Units ◽  
Before And After ◽  
Ultraviolet C ◽  
Vancomycin Resistant ◽  
Tertiary Care Hospitals ◽  
Uv C

Objective.To determine the effectiveness of an automated ultraviolet-C (UV-C) emitter against vancomycin-resistant enterococci (VRE),Clostridium difficile, andAcinetobacterspp. in patient rooms.Design.Prospective cohort study.Setting.Two tertiary care hospitals.Participants.Convenience sample of 39 patient rooms from which a patient infected or colonized with 1 of the 3 targeted pathogens had been discharged.Intervention.Environmental sites were cultured before and after use of an automated UV-C-emitting device in targeted rooms but before standard terminal room disinfection by environmental services.Results.In total, 142 samples were obtained from 27 rooms of patients who were colonized or infected with VRE, 77 samples were obtained from 10 rooms of patients withC. difficileinfection, and 10 samples were obtained from 2 rooms of patients with infections due toAcinetobacter. Use of an automated UV-C-emitting device led to a significant decrease in the total number of colony-forming units (CFUs) of any type of organism (1.07 log10reduction;P< .0001), CFUs of target pathogens (1.35 log10reduction;P< .0001), VRE CFUs (1.68 log10reduction;P< .0001), and C.difficileCFUs (1.16 log10reduction;P< .0001). CFUs ofAcinetobacteralso decreased (1.71 log10reduction), but the trend was not statistically significantP= .25). CFUs were reduced at all 9 of the environmental sites tested. Reductions similarly occurred in direct and indirect line of sight.Conclusions.Our data confirm that automated UV-C-emitting devices can decrease the bioburden of important pathogens in real-world settings such as hospital rooms.

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