Related Experiment Videos
Outbreak of vancomycin-resistant Enterococcus spp. in an Italian general intensive care unit
M Peta1, E Carretto, D Barbarini
1Servizio di Anestesia e Rianimazione II, Area Infettivologica, IRCCS Policlinico San Matteo, Pavia, Italy.
Abstract:
Following the identification of two clinical isolates of vancomycin-resistant enterococci (VRE) from intensive care unit (ICU) patients, a surveillance programme detected that six of eight ICU patients were colonised by VRE. Standard epidemic control measures were instituted in the ICU. During a 16-month period, 13 (2.5%) of 509 ICU patients had VRE-positive swabs upon admission, and 43 (8.7%) of 496 VRE-negative patients were colonised by VRE in the ICU. Patients who acquired VRE in the ICU had a longer ICU stay (p < 0.0001). No other statistically significant differences were demonstrated. Two patients had documented infection (infection/colonisation index, 3.6%; overall VRE infection frequency, 0.4%), but both recovered and were discharged. VRE colonisation did not increase the mortality rate. Automated ribotyping identified three clusters containing, respectively, the first 52 Enterococcus faecium isolates, two Enterococcus faecalis isolates, and two further isolates of E. faecium. Multilocus sequence typing demonstrated that two E. faecium isolates representative of the two ribotypes belonged to sequence types 78 and 18, and that these two isolates belonged to the epidemic lineage C1, which includes isolates with a wide circulation in northern Italy. The outbreak was controlled by continuous implementation of the infection control programme, and by the opening of a new unit with an improved structural design and hand-washing facilities.
Insights
Vancomycin-resistant enterococci (VRE) outbreaks in ICUs can be controlled. Strict infection control measures and improved facilities helped manage VRE colonization and infection in intensive care unit patients.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Vancomycin-resistant enterococci (VRE) pose a significant threat in healthcare settings, particularly intensive care units (ICUs).
- Initial identification of VRE in ICU patients prompted a surveillance program to assess the extent of colonization.
Purpose of the Study:
- To investigate the epidemiology of VRE colonization and infection in an ICU.
- To evaluate the effectiveness of infection control measures in managing a VRE outbreak.
- To characterize the genetic relatedness of VRE isolates.
Main Methods:
- Surveillance cultures were performed on ICU patients.
- Epidemiological data, including patient demographics and length of stay, were collected.
- Automated ribotyping and multilocus sequence typing were used for molecular characterization of VRE isolates.
Main Results:
- VRE colonization was detected in 8.7% of patients admitted as VRE-negative.
- Patients acquiring VRE in the ICU had a significantly longer ICU stay (p < 0.0001).
- VRE colonization did not increase mortality; two infected patients recovered.
- Molecular typing identified three distinct clusters and linked isolates to an epidemic lineage circulating in northern Italy.
Conclusions:
- Continuous implementation of infection control programs is crucial for controlling VRE outbreaks.
- Structural improvements in ICUs, such as enhanced hand-washing facilities, can aid in VRE containment.
- VRE colonization, while associated with longer ICU stays, did not significantly impact mortality in this cohort.
Related Concept Videos
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies. Common...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:28Antimicrobial Effectiveness
01:25Clinical Significance of Antibiotic Resistance
01:17Transmission-based Precautions I: Contact, Enteric, and Droplets
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care