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Control of Endemic Glycopeptide-Resistant Enterococci

Published online by Cambridge University Press:  02 January 2015

Louise M. Dembry ,
Keke Uzokwe  and
Marcus J. Zervos
Louise M. Dembry
Affiliation:
Department of Internal Medicine, Detroit, Michigan Division of Infectious Diseases, Detroit, Michigan Wayne State University School of Medicine, Detroit, Michigan The Yale University School of Medicine, New Haven, Connecticut
Keke Uzokwe
Affiliation:
Department of Internal Medicine, Detroit, Michigan Division of Infectious Diseases, Detroit, Michigan The William Beaumont Hospital, Royal Oak, Michigan
Marcus J. Zervos
Affiliation:
Department of Internal Medicine, Detroit, Michigan Division of Infectious Diseases, Detroit, Michigan Wayne State University School of Medicine, Detroit, Michigan The William Beaumont Hospital, Royal Oak, Michigan
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Abstract

Objective: To evaluate the epidemiology of, and control measures for, vancomycin-resistant Enterococcus (VRE) in a renal unit.

Design: A 3-month, prospective, prevalence culture survey of patients on a 24-bed renal unit.

Setting: A 975-bed community teaching hospital.

Patients: Patients admitted to the renal unit over a 3-month period. Patients identified with VRE were each matched with four patients without VRE isolated over the study period.

Interventions/Control Measures: Resistant-organism barrier precautions. To eradicate carriage of VRE, two patients with VRE stool colonization were treated with 5 days of oral doxycycline (100 mg twice per day) and rifampin (300 mg/day).

Results: Seven patients with VRE (8 isolates) were identified. Five isolates were Enterococcus faecium (vancomycin MIC=16 to 256 μg/mL), two were Enterococcus faecalis (MICs=16 and 124 μg/mL), and one was Enterococcus gallinarum (MIC=8.0 μg/mL). Eradication of carriage with VRE was accomplished in two patients treated with doxycycline and rifampin. In the final 30 days of the culture survey and at 9 months, there were no further patients with VRE identified.

Conclusions: Resistant-organism precautions and elimination of patient carriage may be useful measures for controlling the spread of low-prevalence endemic vancomycin-resistant Enterococcus.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 5 , May 1996 , pp. 286 - 292
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996 

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References

1. Emori, TG, Gaynes, RP. An over view of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428–442.Google Scholar
2. Zervos, MJ, Dembinski, S, Mikesell, T, Schaberg, DR. High-level resistance to gentamicin in Streptococcus faecalis: risk factors and evidence for exogenous acquisition of infection. J Infect Dis 1986;153:1075–1083.Google Scholar
3. Zervos, MJ, Kauffman, CA, Therasse, PM, Bergman, AG, Mikesell, TS, Schaberg, DR. Nosocomial infection with gentamicin-resistant Streptococcus faecalis: an epidemiologic study. Ann Intern Med 1987;106:687–691.Google Scholar
4. Murray, BE, Singh, KV, Markowitz, SM, et al. Evidence for clonal spread of a single strain of β-lactamase–producing Enterococcus (Streptococcus) faecalis to six hospitals in five states. J Infect Dis 1991;163:780–785.Google Scholar
5. Rhinehart, E, Smith, NE, Wennersten, C, et al. Rapid dissemination of beta-lactamase-producing, aminoglycoside-resistant Enterococcus faecalis among patients and staff on a infant-toddler surgical ward. N Engl J Med 1990;323:1814–1818.Google Scholar
6. Boyce, JM, Opal, SM, Potter-Bynoe, G, et al. Emergence and nosocomial transmission of ampicillin-resistant enterococci. Antimicrob Agents Chemother 1992;36:1032–1039.Google Scholar
7. Karanfil, LV, Murphy, M, Josephson, A, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195–200.Google Scholar
8. Livornese, LL, Dias, S, Samel, C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.Google Scholar
9. Rubin, LG, Tucci, V, Cercenado, E, Eliopoulos, G, Isenberg, HD. Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700–705.Google Scholar
10. Chirurgi, VA, Oster, SE, Goldberg, AA, McCabe, RE. Nosocomial acquisition of beta-lactamase–negative, ampicillin-resistant enterococcus. Arch Intern Med 1992;152:1457–1461.Google Scholar
11. Boyce, JM, Opal, SM, Chow, JW, et al. An outbreak of multi-drug resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
12. Chow, JW, Kuritza, A, Shlaes, DM, et al. Clonal spread of vancomycin-resistant Enterococcus faecium between patients in three hospitals in two states. J Clin Microbiol 1993;31:1609–1611.Google Scholar
13. Handwerger, S, Raucher, B, Altarac, D, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.Google Scholar
14. Murray, BE, Mederski-Samaroj, B. Transferable β-lactamase: a new mechanism for in vitro penicillin resistance in Streptococcus faecalis . J Clin Invest 1983;72:1168–1171.Google Scholar
15. Grayson, ML, Eliopoulis, GM, Wennersten, CB, et al. Increasing resistance to β-lactam antibiotics among clinical isolates of Enterococcus faecium: a 22-year review at one institution. Antimicrob Agents Chemother 1991;35:2180–2184.Google Scholar
16. Patterson, JE, Zervos, MJ. High-level gentamicin resistance in Enterococcus; microbiology, genetic basis, and epidemiology. Rev Infect Dis 1990;12:644–652.Google Scholar
17. Uttley, AHC, Collins, CH, Naidoo, J, George, RC. Vancomycin-resistant enterococci. Lancet 1988;1:57–58.Google Scholar
18. Leclercq, R, Derlot, E, Duval, J, Courvalin, P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium . N Engl J Med 1988;319:157–161.Google Scholar
19. Shlaes, DM, Bouvet, A, Devine, C, Shlaes, JH, Al-Obeid, S, Williamson, R. Inducible, transferable resistance to vancomycin-resistance in Enterococcus faecalis A256. Antimicrob Agents Chemother 1989;33:198–203.Google Scholar
20. Green, M, Wadowsky, RM, Barbadora, K. Recovery of vancomycin-resistant gram-positive cocci from children. J Clin Microbiol 1990;28:484–488.Google Scholar
21. National Nosocomial Infections Surveillance System. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
22. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
23. McCabe, WR, Jackson, GG. Gram-negative bacteremia; I: etiology and ecology. Arch Intern Med 1962;110:847–855.Google Scholar
24. Facklam, RR, Collins, MD. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol 1989;27:731–734.Google Scholar
25. National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Villanova, PA; 1985. Approved Standard M7-A.Google Scholar
26. Jones, RN, Barry, AL, Gavan, TL, Washington, JA II. Susceptibility tests: microdilution and macrodilution broth procedures. In: Lennette, EH, Balows, A, Hausler, WJ Jr Shadomy, HJ, eds. Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology; 1985:972–977.Google Scholar
27. Moellering, RC, Wennersten, CBG, Weinberg, AN. Studies on antibiotic synergism against enterococci; I: bacteriologic studies. J Lab Clin Med 1971;77:821–828.Google Scholar
28. Murray, BE, Singh, KV, Heath, JD, Sharma, BR, Weinstock, GM. Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites. J Clin Microbiol 1990;28:2059–2063.Google Scholar
29. Donabedian, SM, Chow, JW, Boyce, JM, et al. Molecular typing of ampicillin-resistant, non-beta-lactamase–producing Enterococcus faecium isolates from diverse geographic areas. J Clin Microbiol 1992;30:2757–2761.Google Scholar
30. Dembry, LM, Vazquez, JA, Zervos, MJ. DNA analysis in the study of the epidemiology of nosocomial candidiasis. Infect Control Hosp Epidemiol 1994;15:48–53.Google Scholar
31. Kim, KH, Fekety, R, Batt, DH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis 1981;143:42–50.Google Scholar
32. Linden, P, Pasculle, AW, Manez, R, Kramer, D, Martin, M, Starzl, T. Failure of oral doxycycline to eradicate fecal carriage of vancomycin-resistant Enterococcus faecium. Proceedings of the 92nd General Meeting of the American Society for Microbiology; New Orleans, LA; May 1992.Google Scholar
33. Arocella, G. Pharmacokinetics and metabolism of rifampin in humans. Rev Infect Dis 1983;5(suppl):428.Google Scholar
34. Advenier, C, Gobert, C, Hovin, G. Pharmacokinetic studies of rifampicin in the elderly. Ther Drug Monit 1983;5:61–65.Google Scholar
35. Mulligan, ME, Murray-Leisure, KA, Ribner, BS, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.Google Scholar
36. Smith, GE, Kennedy, CTC. Staphylococcus aureus resistant to mupirocin. J Antimicrob Chemother 1988;21:141–142.Google Scholar