Related Experiment Videos
Insights into the epidemiology and control of infection with vancomycin-resistant enterococci
1Department of Internal Medicine, Section of Infectious Disease, Rush Medical College, Chicago, IL, USA. mhayden@rush.edu
Abstract:
Despite control efforts, the incidence of nosocomial infections due to vancomycin-resistant enterococci (VRE) continues to increase in the United States. VRE are thought to spread primarily by cross-contamination. Recent molecular epidemiologic studies have refined our understanding of this phenomenon. If VRE are not controlled soon after introduction into a hospital, sporadic cases may evolve into a monoclonal outbreak, which may then evolve to polyclonal endemicity. An intervention that is effective in containing VRE in one setting may be ineffective in another. Control of VRE where they are endemic is particularly challenging. Although eradication of endemic VRE may not be possible, aggressive, multifaceted programs have been successful in diminishing the problem. A mathematical model of transmission of VRE and the effect of infection control measures in settings where they are endemic has been reported. The use of such a model may allow more precise determination of the impact of control strategies in the future.
Insights
Vancomycin-resistant enterococci (VRE) hospital infections are rising. Effective control requires understanding transmission dynamics and tailored, multifaceted strategies, especially in endemic settings.
Area of Science:
- Infectious Diseases
- Epidemiology
- Healthcare Management
Background:
- Nosocomial infections caused by vancomycin-resistant enterococci (VRE) are a growing public health concern in the United States.
- VRE transmission is primarily attributed to cross-contamination within healthcare settings.
- The progression from sporadic cases to endemicity presents significant control challenges.
Purpose of the Study:
- To analyze the molecular epidemiology of vancomycin-resistant enterococci (VRE) transmission.
- To evaluate the effectiveness of various control interventions in different healthcare settings.
- To explore the potential of mathematical modeling for predicting VRE spread and intervention impact.
Main Methods:
- Review of recent molecular epidemiologic studies on VRE transmission patterns.
- Analysis of intervention effectiveness across diverse healthcare environments.
- Examination of a mathematical model simulating VRE transmission and control measures.
Main Results:
- VRE can evolve from sporadic cases to endemic polyclonal status if not controlled early.
- Intervention effectiveness varies significantly depending on the healthcare setting and VRE endemicity.
- Aggressive, multifaceted programs can diminish VRE prevalence even in endemic situations.
Conclusions:
- Controlling VRE requires adaptable strategies tailored to specific hospital environments and endemicity levels.
- Mathematical modeling offers a promising tool for optimizing VRE control strategies.
- While eradication may be difficult, significant reduction of VRE is achievable through comprehensive infection control efforts.