Colonización por microorganismos multirresistentes en servicio de oncología de Hospital de Niños Roberto del Río durante el 2016 / Colonization by multiresistant microorganisms in oncology service of Roberto del Río Children's Hospital during 2016

Los pacientes inmunocomprometidos presentan un riesgo aumentado de colonización e infecciones por microorganismos multirresistentes (MOR), entre ellos Enterococcus spp resistentes a vancomicina (ERV) y bacterias productoras de betalactamasas de espectro extendido (BLEE), las cuales son causa importante de morbimortalidad. OBJETIVO: Describir la prevalencia de MOR en Servicio de Oncología del Hospital Roberto del Río. MÉTODO: Se realizó un estudio descriptivo retrospectivo de los niños hospitalizados en el servicio de oncología desde enero a diciembre del 2016 a los cuales se les realizó vigilancia de portación de ERV y BLEE. RESULTADOS: De los 97 pacientes hospitalizados, se identificó un 8% de portación de ERV, un 13,7% de BLEE y un 6,8% presentó portación de ambos microorganismos. DISCUSIÓN: Entre enero 2012 a diciembre del 2013 se observó en nuestro centro que un 52% de los pacientes hospitalizados en oncología estaban colonizados por ERV, la disminución significativa de la portación podría deberse a la mejor adherencia de normas de prevención de infecciones asociadas a la atención en salud (IAAS), programa de uso racional de antimicrobianos y a la nueva infraestructura del servicio.

The inmunosupressed patients are at increased risk of colonization and infection with vancomycin resistant Enterococci (VRE) and extended- spectrum b-lactamase producing Enterobacteriaceae (ESBL), which can cause substantial morbidity and mortality. OBJECTIVE: Describe the prevalence of VRE and ESBL in the Oncology Unit of Roberto del Río Hospital. METHODS: Descriptive and retrospective study of hospitalized children since January to December 2016 in the Oncology Unit, that underwent VRE and ESBL colonization surveillance. RESULTS: From the 97 hospitalized patients, there were 8% of VRE colonization, 13.7% of ESBL and 6.8% of colonization from both microorganism. DISCUSSION: Between January 2012 and December 2013, we observed that 52% of hospitalized patients in the Oncology Unit were colonized by VRE. The significant decrease in colonization may be due to better fulfillment of healthcare-associated infections (HAI) normative, antibiotics stewardship and new infraestructure of our unit.

Factores asociados a colonización por enterococo sp resistente a vancomicina en una unidad de cuidados intensivos pediátricos del Paraguay: estudio transversal sobre historias clínicas / Factors associated with vancomycin-resistant enterococcus colonization in a pediatric intensive care unit of Paraguay: a cross-sectional study on hospital charts

INTRODUCCIÓN Las infecciones por Enterococcus sp resistente a la vancomicina se han diseminado y generan un desafío clínico-terapéutico en los pacientes hospitalizados. La amenaza de que la infección por enterococos intratables y la posibilidad que la resistencia a la vancomicina pueda propagarse a neumococos o estafilococos, abogan por la vigilancia atenta de las cepas resistentes. OBJETIVO Determinar los factores de riesgos asociados a la portación de Enterococcus sp resistente a la vancomicina en pacientes pediátricos ingresados en una unidad de cuidados intensivos pediátricos del Paraguay en el periodo entre enero de 2012 y junio de 2013. MÉTODOS Estudio transversal. Se analizaron las historias clínicas previas de 140 pacientes ingresados a terapia intensiva (niños de un mes a 18 años), a quienes se realizaron cultivos de hisopado rectal dentro de las 48 horas del ingreso, para determinar los factores asociados a la portación de Enterococcus sp resistente a la vancomicina en unidad de cuidados intensivos pediátricos. Se calculó el Odd ratio con sus intervalos de confianza y p < 0,05 para las variables de estudio. Posteriormente, se realizó regresión logística múltiple para las variables estadísticamente significativas. RESULTADOS La portación de Enterococcus sp resistente a la vancomicina se observó en 18,6% de los pacientes. Se identificaron como factores asociados: la hospitalización previa durante el último año (Odds ratio: 10,8; intervalo de confianza 95%: 2,43 a 47,8; p = 0,001), uso previo de antibióticos de amplio espectro (Odds ratio: 5,05; intervalo de confianza 95%: 2,04 a 12,5; p = 0,000), uso de dos o más antibióticos de amplio espectro en el último año (Odds ratio: 5,4; intervalo de confianza 95%: 1,5 a 18,4; p = 0,009), internación previa en área de alto riesgo (Odds ratio: 4,91; intervalo de confianza 95%: 1,83 a 13,2; p = 0,000), internación por igual o mayor a seis días en área de alto riesgo (Odds ratio: 5,64; intervalo de confianza 95%: 2,18 a 14,6; p = 0,000) y uso de inmunosupresores (Odds ratio: 4,84; intervalo de confianza 95%: 1,92 a 11,9; p = 0,001). La regresión múltiple señala a la utilización de dos o más antibióticos de amplio espectro (Odds ratio: 4,81; intervalo de confianza 95%: 1,01 a 22,8; p = 0,047) y a la historia de hospitalización previa dentro del año (Odds ratio: 7,84; intervalo de confianza 95%: 1,24 a 49,32; p = 0,028) como factores independientes asociados estadísticamente con la portación de Enterococcus sp resistente a la vancomicina. CONCLUSIÓN Los pacientes pediátricos ingresados en la unidad de cuidados intensivos con historia de internación previa dentro del año y la exposición a dos o más antibióticos de amplio espectro, tienen mayor riesgo de colonización por el enterococo resistente a vancomicina.

INTRODUCTION Vancomycin-resistant enterococcus (VRE) infections have become widespread and a challenge in hospitalized patients. The threat of infection by intractable enterococci and the possibility that vancomycin resistance could involve pneumococci or staphylococci advocate for careful surveillance of resistant strains. OBJECTIVE To determine the risk factors associated with VRE colonization in pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) in the period between January 2012 and June 2013. METHODS We conducted a cross-sectional study analyzing the clinical histories of 140 patients admitted to the PICU (children from 1 month to 18 years), who underwent rectal swab cultures within 48 hours of admission. We calculated the odds ratios and confidence intervals of the risk factors for VRE colonization in the PICU, and then we used multiple logistic regression for the statistically significant variables. RESULTS VRE colonization was present in 18.6% of patients. The following were identified as risk factors associated to VRE colonization: hospitalization during the previous year (odds ratio: 10.8, 95% confidence interval: 2.43 to 47.8; p = 0.001), prior use of one broad-spectrum antibiotic (odds ratio: 5.05; 95% confidence interval: 2.04 to 12.5; p = 0.000), use of two or more broad-spectrum antibiotics in the last year (odds ratio: 5.4, 95% confidence interval: 1.5 to 18.4; p = 0.009), prior hospitalization in the risk area (odds ratio: 4.91, 95% confidence interval: 1.83 to 13.2; p = 0.000), hospitalization for more than five days in high-risk area (odds ratio: 5.64, 95% confidence interval: 2.18 to 14.6; p = 0.000), and use of immunosuppressant drugs (odds ratio: 4.84, 95% confidence interval: 1.92 to 11.9; p = 0.001). In a logistic multiple regression the use of two or more broad-spectrum antibiotics (odds ratio: 4.81, 95% confidence interval: 1.01 to 22.8; p = 0.047) and the history of prior hospitalization in the last year (odds ratio: 7.84, 95% confidence interval: 1.24 to 49.32, p = 0.028) were identified as independent factors statistically associated with VRE colonization. CONCLUSION Pediatric patients admitted to the Intensive Care Unit with a history of prior hospitalization in the previous year, and exposure to two or more broad-spectrum antibiotics have a greater risk of colonization by vancomycin-resistant enterococcus.

Clonal dissemination of vancomycin-resistant Enterococcus faecium ST412 in a Brazilian region

ABSTRACT Vancomycin-resistant Enterococcus faecium (VREfm) has emerged as an important global nosocomial pathogen, and this trend is associated with the spread of high-risk clones. Here, we determined the genetic and phenotypic features of 93 VREfm isolates that were obtained from patients in 13 hospitals in Vitória, Espírito Santo, Brazil, during 2012-2013. All the isolates were vancomycin-resistant and harbored the vanA gene. Only 6 (6.5%) of the VREfm isolates showed the ability to form biofilm. The 93 isolates analyzed belong to a single pulsed-field gel electrophoresis lineage and presented six subtypes. MLST genotyping showed that all VREfm belonged to ST412 (the high-risk clone, hospital-adapted). The present study describes the dissemination of ST412 clone in the local hospitals. The clonal spread of these ST412 isolates in the area we analyzed as well as other hospitals in southeastern Brazil supports the importance of identifying and controlling the presence of these microorganisms in health care-related services.

Evaluation of a selective chromogenic medium for detecting vancomycin-resistant enterococci

ABSTRACT Rapid identification of vancomycin-resistant enterococci (VRE) can assist in choosing the appropriate treatment and preventing VRE spread. The performance of chromIDTM VRE agar was evaluated using 184 clinical isolates of Enterococcus spp. and reference strains. The test had a sensitivity of 95.52% but a low specificity of 30%.

Colonización por enterococo resistente a vancomicina en pacientes internados en un hospital de Lima, Perú / Colonization by Enterococcal Strains Resistant to Vancomycin in Patients from a Hospital in Lima, Peru

RESUMEN Con el objetivo de determinar la frecuencia de colonización por el enterococo resistente a vancomicina (ERV), el genotipo de resistencia y los factores asociados, se realizó un estudio de tipo transversal durante noviembre y diciembre del 2013 en el Hospital Nacional Cayetano Heredia en Lima, Perú. Se encontró una frecuencia de colonización por ERV de 6,2% (IC 95%: 1,67-10,73), todas las cepas aisladas tenían el genotipo de resistencia vanA, y se halló que las variables hospitalización previa (p=0,001) y el uso de cefalosporinas de tercera generación (p=0,016) estaban asociadas a la colonización por ERV. En conclusión, existe colonización perianal por ERV en los diversos servicios de hospitalización, el gen vanA podría ser transmitido a gérmenes más virulentos y ocasionar la aparición de la bacteria Staphylococcus aureus resistente a vancomicina (VRSA). Es necesario adoptar medidas de control de infecciones para evitar la transmisión de esta bacteria en el ambiente hospitalario.

ABSTRACT This cross-sectional study was conducted from November to December of 2013 at the Cayetano Heredia National Hospital in Lima, Peru, to determine the rate of infection with vancomycin-resistant enterococcus (VRE), the resistance genotype, and associated factors. The rate of infection with VRE was 6.2% (95% confidence interval [CI]: 1.67-10.73) and the resistance genotype isolated from all strains was the vanA gene. The factors associated with colonization with VRE were previous hospitalizations (p = 0.001) and the use of third-generation cephalosporins (p = 0.016). In conclusion, perianal colonization with VRE is present in many hospital services. Moreover, the vanA gene may cause resistance to vancomycin and promote the development of vancomycin-resistant Staphylococcus aureus. Therefore, infection control measures should be adopted to prevent the dissemination of this bacterial strain in hospital settings.

Detection of vancomycin-resistant enterococci (VRE) in stool specimens submitted for Clostridium difficile toxin testing

Abstract The aim of this study was to determine the association between Clostridium difficile (C. difficile) and vancomycin-resistant Enterococcus (VRE) and efficacy of screening stools submitted for C. difficile toxin assay for prevalence of VRE. Between April 2012 and February 2014, 158 stool samples submitted for C. difficile toxin to the Marmara University Microbiology Laboratory, were included in the study. Stool samples were analyzed by enzyme immuno assay test; VIDAS (bioMerieux, France) for Toxin A&B. Samples were inoculated on chromID VRE (bioMerieux, France) and incubated 24 h at 37 °C. Manuel tests and API20 STREP (bioMerieux, France) test were used to identify the Enterococci species. After the species identification, vancomycin and teicoplanin MIC's were performed by E test and molecular resistance genes for vanA vs vanB were detected by polymerase chain reaction (PCR). Of the 158 stool samples, 88 were toxin positive. The prevalence of VRE was 17%(n:19) in toxin positives however, 11.4% in toxin negatives(n:70). All VRE isolates were identified as Enterococcus faecium. These results were evaluated according to Fischer's exact chi-square test and p value between VRE colonization and C. difficile toxin positivity was detected 0.047 (p < 0.05). PPV and NPV were 79% and 47% respectively. In our study, the presence of VRE in C. difficile toxin positives is statistically significant compared with toxin negatives (p < 0.05). Screening for VRE is both additional cost and work load for the laboratories. Therefore VRE screening among C. difficile toxin positive samples, will be cost effective for determination of high risk patients in the hospitals especially for developing countries.

Normas 2017 de contención de infecciones por gérmenes productores de carbapenemasas del Hospital Nacional de Itauguá, Paraguay / 2017 regulations for the containment of carbapenemase-producing infections of the National Hospital of Itauguá, Paraguay

La carbapenemasa es una enzima producida por varias especies bacterianas, capaz de inactivar un grupo de antibióticos: los carbapenemes. El riesgo radica, además de la dificultad para el tratamiento de las infecciones resistentes a estos antibióticos, en su fácil diseminación entre especies bacterianas, entre pacientes y entre pacientes y contactos (familiares, personal de salud, etc.) Su sigla KPC se generalizó desde el primer caso se dio en la Klebsiella pneumoniae. Se publican Normas que tienen el objetivo de prevenir y controlar la colonización e infección de pacientes con gérmenes productores de carbapenemasa (tipo KPC-NDM etc.) en el Hospital Nacional.

Carbapenemase is an enzyme produced by several bacterial species, capable of inactivating a group of antibiotics: carbapenems. In addition to the difficulty in treating infections resistant to these antibiotics, the risk lies in their easy spread among bacterial species, between patients and between patients and contacts (family members, health personnel, etc.). Its initials KPC was generalized since the first case that occurred in Klebsiella pneumoniae. Guidelines that aim to prevent and control the colonization and infection of patients with carbape

La resistencia a vancomicina más allá de los enterococos / Resistance to vancomycin beyond enterococci

La vancomicina (VAN) es un glucopéptido que inhibe la síntesis de la pared celular y con el tiempo se había transformado en la droga de elección para el tratamiento de infecciones graves por gram positivos. La resistencia observada en enterococos y la sensibilidad disminuida registrada en estafilococos hasta cierto punto han limitado su uso. La aparición de estreptococos del grupo viridans y del grupo B con marcadores de resistencia a vancomicina enciende un alerta en función de su posible pasaje a neumococos y Streptococcus pyogenes (AU)

Vancomycin (VAN) is a glycopeptide inhibiting cell-wall synthesis and has become the drug of choice for the treatment of severe gram-positive infections. Resistance observed in enterococci and decreased sensitivity in staphylococci have to a certain point limited its use. The appearance of the viridans group and group B streptococci showing markers for resistance to vancomycin have caused an alert regarding the possible passage to pneumococci and Streptococcus pyogenes (AU)

Análisis de mortalidad debida a una infección del torrente sanguíneo por Enterococcus faecium en Taiwán central / Mortality analysis of Enterococcus faecium bloodstream infection in central Taiwan

Background: Bloodstream infections (BSIs) due to Enterococcus faecium (E. faecium), particularly those due to vancomycin-resistant enterococcus (VRE), are still a therapeutic challenge. Aim: To evaluate mortality from BSI due to E. faecium and VRE in central Taiwan. Materials and Methods: We retrospectively analyzed cases of significant E. faecium BSI in the Changhua Christian Hospital System between January 1, 2010 and December 31, 2013. Results: Of the 76 cases, 28 patients (36.8%) were admitted to intensive care units (ICUs) at the onset of BSI, 10 (13.2%) cases were associated with polymicrobial bacteremia, and 29 (38.2%) cases were associated with entry via the biliary tract. VRE was observed in 18 (23.7%) cases. The 30-day mortality rate was 13.1% (10/76). Multivariate logistic regression analysis showed that bacteremia of non-biliary tract origin (OR = 8.43, 95% confidence interval (95% CI) = 1.32-54.00, p = 0.002) and ICU admission (OR = 4.2, 95% CI = 1.7-10.0, p = 0.002) were significant risk factors for 30-day mortality, whereas appropriate antimicrobial therapy was a protective factor for 30-day mortality (OR = 0.33, 95% CI = 0.14-0.79, p = 0.013). Conclusions: Our results underscore the need to assist patients admitted to ICUs with E. faecium BSIs with a non-biliary tract origin. We emphasize the use of appropriate antimicrobial therapy for E. faecium BSI with the aim to rescue more patients with these infections.

Antecedentes: Las infecciones del torrente sanguíneo por Enterococcus faecium, particularmente aquellas causadas por enterococos resistentes a vancomicina (ERV), representan aún un desafío para los tratamientos. Este estudio está orientado a la evaluación de la mortalidad debido a la infección del torrente sanguíneo (ITS) por E. faecium y por enterococos resistentes a vancomicina (ERV) en Taiwán central. Materiales y Métodos: Analizamos de forma retrospectiva casos de ITS causadas por E. faecium genuinas en el Sistema del Hospital Changhua Christian, entre los días 1 de enero de 2010 y 31 de diciembre de 2013. Resultados: De los 76 casos analizados, 28 pacientes fueron ingresados a las Unidades de Cuidados Intensivos (UCI) al comienzo de una ITS (36,8%), 10 casos fueron asociados a bacteriemia polimicrobiana (13,2%), y 29 casos tuvieron como puerta de entrada la vía biliar. En 18 casos se pudieron observar ERV (23,7%). La mortalidad a 30 días fue de 13,1% (10/76). El análisis multivariado mediante regresión logística mostró que la bacteriemia de origen no biliar (OR = 8,43, 95% intervalo de confianza (95% CI) = 1,32-54,00; p = 0,002), y el ingreso a la UCI (OR = 4,2; 95% CI = 1,7-10,0; p = 0,002), fueron factores de riesgo significativos para el rango de mortalidad de 30 días, así como un tratamiento de antimicrobiano apropiado constituye un factor protector en contra la mortalidad (OR = 0,33; 95% CI = 0,14-0,79; p = 0,013). Conclusiones: Nuestros resultados destacan la necesidad de asistir a los pacientes ingresados a la UCI con ITS por E. faecium con origen no biliar. Hacemos énfasis a la aplicación de una antibioterapia adecuada para sacar adelante a un mayor número de pacientes con este tipo de infecciones.

Healthcare-associated vancomycin resistant Enterococcus faecium infections in the Mansoura University Hospitals intensive care units, Egypt

Vancomycin resistant Enterococcus faecium (VREF) ia an emerging and challenging nosocomial pathogen. This study aimed to determine the prevalence, risk factors and clonal relationships between different VREF isolates in the intensive care units (ICUs) of the university hospitals in our geographic location. This prospective study was conducted from July, 2012 until September, 2013 on 781 patients who were admitted to the ICUs of the Mansoura University Hospitals (MUHs), and fulfilled the healthcare-associated infection (HAI) criteria. Susceptibility testing was determined using the disk diffusion method. The clonal relationships were evaluated with pulsed field gel electrophoresis (PFGE). Out of 52 E. faecium isolates, 12 (23.1%) were vancomycin resistant. The significant risk factors for the VREF infections were: transfer to the ICU from a ward, renal failure, an extended ICU stay and use of third-generation cephalosporins, gentamicin, or ciprofloxacin. PFGE with the 12 isolates showed 9 different patterns; 3 belonged to the same pulsotype and another 2 carried a second pulsotypes. The similar pulsotypes isolates were isolated from ICUs of one hospital (EICUs); however, all of the isolates from the other ICUs had different patterns. Infection control policy, in conjunction with antibiotic stewardship, is important to combat VREF transmission in these high-risk patients.

Enterococcus spp. resistentes à vancomicina: características clínicas efatores de risco / Vancomycin-resistant Enterococcus spp: clinical characteristics and risk factors

Enterococcus spp. resistentes à vancomicina (ERV) têm emergido como um patógeno multirresistente relevante e de etiologia potencialmente letal nas infecções associadas à assistência em saúde ao redor do mundo. Este estudo pretende mostrar epidemiologia e características clínicas de pacientes com ERV em um hospital do sul do Brasil. Um estudo retrospectivo foi conduzido no período de janeiro de 2005 a novembro de 2007 no Hospital Universitário de Londrina. Todos os pacientes com cultura clínica com ERV foram identificados e seu prontuário médico revisado. A presença de colonização foi avaliada através de culturas de swab retal e a identificação das amostras clínicas foi realizada pelo método automatizado MicroScan®. A média de idade dos pacientes foi de 54 anos. Trato urinário (68,0%) e corrente sanguínea (23,8%) foram os sítios mais frequentes, e a UTI apresentou se como setor de maior ocorrência (49,2%) das culturas positivas. E. faecium foi a espécie predominante, em 82,8% dos casos. Os fatores de risco observados foram a duração da internação (média de 58,2 dias), uso de antimicrobianos prévios e realização de procedimento invasivos, como o uso de cateter venoso central, sonda vesical e ventilação mecânica. Medidas de controle e culturas de vigilância são imprescindíveis no controle da disseminação do ERV. Os resultados obtidos no presente trabalho contribuem para uma melhor compreensão da dinâmica epidemiológica das infecções e da disseminação do ERV no Hospital Universitário de Londrina.

Vancomycin-resistant Enterococci (VRE) have emerged as a relevant multidrug-resistant pathogen and potencially lethal etiology of healthcare associated infections worldwide. This study intends to show the epidemiology and clinical characteristics of patients with VRE in a Hospital in South Brazil. A retrospective study was conducted from January 2005 to November 2007. A total of 122 VRE were identified in this period at the University Hospital of Londrina. All patients with VRE clinical culture have identified and their medical records have reviewed. The presence of colonization was evaluated through rectal swab cultures, and the species identification of clinical samples was performed by automated method MicroScan®. The mean age of patients was 54 years. Urinary tract (68.0%) and blood (23.8%) were the most frequent sites, and ICU was the largest sector of occurrence (49.2%). E. faecium was the predominant species, in 82.8% of cases.The risk factors presents were length of hospitalization (mean 58.2 days), previous use of antimicrobials and invasive procedure, such as use of central venous catheter, urinary catheter and mechanical ventilation. Control barriers and surveillance cultures are essential to prevent the VRE spread. The results obtained in this study contribute to a better understanding of the epidemiological dynamics of infections and the spread of VRE in University Hospital of Londrina.

Factores de riesgo de colonización por Enterococcus spp resistente a vancomicina en pacientes pediátricos hospitalizados con patología oncológica / Risk factor of intestinal colonization with vancomycin resistant Enterococcus spp in hospitalized pediatric patients with oncological disease

Background: The isolation of vancomycin-resistant Enterococcus spp (ERV) has increased significantly within the last few years, along with the risk of infection and dissemination of these bacteria. Our aim was to determine risk factors (RF) for intestinal colonization in hospitalized pediatric patients with oncological disease at Hospital de Niños Roberto del Río. Methods: Between January 2012 and December 2013 a transversal study was performed with 107 rectal swabs and processed with a PCR for ERV. The patients were classified as "colonized with ERV" and "not colonized with ERV" and we evaluated possible RF for intestinal colonization in both groups. Results: VRE colonization was found in 51 patients (52%). The median of time elapsed between oncological diagnosis and VRE colonization was 35 days. The significant RF associated with VRE colonization were days of hospitalization prior to study, neutropenia and treatment with antibiotics within 30 days prior to study and mucositis. Conclusions: According to the RF revealed in this study we may suggest prevention standards to avoid ERV colonization. This is the first investigation in our country in hospitalized pediatric patients with oncological disease and processed with a multiplex PCR for ERV, therefore it is a great contribution about this subject in Chile.

Introducción: El aislamiento de Enterococcus spp resistentes a vancomicina (ERV) ha presentado un incremento significativo en los últimos años, aumentando el riesgo de infección por esta bacteria y favoreciendo su diseminación. Nuestro objetivo es determinar los factores de riesgo (FR) de colonización intestinal de ERV en pacientes oncológicos internados en el Hospital de Niños Roberto del Río. Método: Entre enero de 2012 y diciembre de 2013 se realizó un estudio transversal de colonización rectal por ERV mediante muestras de hisopado rectal obtenidas en 107 pacientes efectuando RPC múltiple para ERV. Se dividió en grupo "portador" y "no portador" y se evaluó los posibles FR para colonización por ERV. Resultados: Se encontró colonización por ERV en 51 pacientes (52%). El tiempo transcurrido desde el diagnóstico oncológico y la colonización presentó una mediana de 35 días. Los FR encontrados con asociación significativa fueron el número de días de hospitalización previa, neutropenia, uso de antimicrobianos 30 días previos y mucositis. Conclusión: De acuerdo a los FR encontrados podemos sugerir medidas de prevención para colonización por ERV. Esta es la primera investigación realizada en nuestro país en pacientes oncológicos pediátricos y que utiliza la técnica de RPC múltiple para ERV, lo que permite un aporte significativo sobre este tema en Chile.

Detection of both vanA & vanB genes in vanA phenotypes of Enterococci by Taq Man RT-PCR

Twenty seven isolates of vancomycin resistant Enterococci based on the disk diffusion and E- test have been screened; being found eight (0.3%) clinical isolates of vanA & vanB through Taq Man Real Time PCR assay. This study shows the presence of both vanA & vanB genotypes in vanA phenotypes clinical isolates in the three hospitals in Iran.

Risk of vancomycin-resistant enterococci bloodstream infection among patients colonized with vancomycin-resistant enterococci

Background: Vancomycin-resistant enterococci colonization has been reported to increase the risk of developing infections, including bloodstream infections. Aim: In this study, we aimed to share our experience with the vancomycin-resistant enterococci bloodstream infections following gastrointestinal vancomycin-resistant enterococci colonization in pediatric population during a period of 18 months. Method: A retrospective cohort of children admitted to a 400-bed tertiary teaching hospital in Izmir, Turkey whose vancomycin-resistant enterococci colonization was newly detected during routine surveillances for gastrointestinal vancomycin-resistant enterococci colonization during the period of January 2009 and December 2012 were included in this study. All vancomycin-resistant enterococci isolates found within 18 months after initial detection were evaluated for evidence of infection. Findings: Two hundred and sixteen patients with vancomycin-resistant enterococci were included in the study. Vancomycin-resistant enterococci colonization was detected in 136 patients (62.3%) while they were hospitalized at intensive care units; while the remaining majority (33.0%) were hospitalized at hematology-oncology department. Vancomycinresistant enterococci bacteremia was present only in three (1.55%) patients. All these patients were immunosuppressed due to human immunodeficiency virus (one patient) and intensive chemotherapy (two patients). Conclusion: In conclusion, our study found that 1.55% of vancomycin-resistant enterococcicolonized children had developed vancomycin-resistant enterococci bloodstream infection among the pediatric intensive care unit and hematology/oncology patients; according to our findings, we suggest that immunosupression is the key point for developing vancomycinresistant enterococci bloodstream infections. .

Prevalencia de Enterococos resistentes a la vancomicina en un Servicio de Cuidados Intensivos de Adultos / Prevalence of vancomicyn resistant Enterococci in an Adult Intensive Care Unit

Los enterococos son microorganismos anaerobios Gram-positivos, que forman parte de la flora microbiana normal del intestino del hombre, se han expandido en diferentes partes del mundo, agregando morbilidad, letalidad y aumento de los costos de hospitalización. Este trabajo tuvo como objetivo determinar la prevalencia de Enterococo resistente a vancomicina en pacientes internados en Unidad de Cuidados Intensivos del Hospital Nacional de Itauguá, Paraguay, en fecha 02 de setiembre de 2013. Diseño observacional, descriptivo de corte transverso, estudio de prevalencia. Constituido por 22 pacientes, en todo momento se respetó la confidencialidad de la información. Resultados: 54,5% fueron EVR positivos; todos mayores de 20 años; mayoritariamente de sexo masculino; procedentes del interior del país, como motivo de ingreso, predominaron las patologías quirúrgicas. Con un promedio de estancia de 7,5 días. Al concluir el trabajo se dejó las recomendaciones de continuar con el aislamiento de contacto además del estándar, la toma de muestra a los nuevos ingresos; asegurar la provisión de insumos para la implementación del aislamiento recomendado.

Enterococci are Gram-positive anaerobic microorganisms, which are part of the normal microbial flora of the human intestine, have expanded around the world, adding morbidity, mortality and increased hospitalization costs. This study to determine the prevalence of vancomycin-resistant Enterococcus in patients in Intensive Care Unit of the National Hospital of Itauguá, Paraguay, dated 02 September 2013. observational, descriptive design transverse cutting prevalence study. Consisting of 22 patients, at all times the confidentiality of the information is respected. Results: 54.5% were positive EVR; all older than 20 years; mostly male; from inside the country as reason for admission, predominance of surgical pathologies. With an average stay of 7.5 days. At the conclusion of the work the recommendations were to continue the contact isolation in addition to the standard sampling of new admissions; as well as to ensure the provision of facilities to implement the recommended isolation.

The first report of the vanC1 gene in Enterococcus faecium isolated from a human clinical specimen

The vanC1 gene, which is chromosomally located, confers resistance to vancomycin and serves as a species marker for Enterococcus gallinarum. Enterococcus faecium TJ4031 was isolated from a blood culture and harbours the vanC1gene. Polymerase chain reaction (PCR) assays were performed to detect vanXYc and vanTc genes. Only the vanXYc gene was found in the E. faecium TJ4031 isolate. The minimum inhibitory concentrations of vancomycin and teicoplanin were 2 µg/mL and 1 µg/mL, respectively. Real-time reverse transcription-PCR results revealed that the vanC1and vanXYc genes were not expressed. Pulsed-field gel electrophoresis and southern hybridisation results showed that the vanC1 gene was encoded in the chromosome. E. faecalis isolated from animals has been reported to harbour vanC1gene. However, this study is the first to report the presence of the vanC1gene in E. faecium of human origin. Additionally, our research showed the vanC1gene cannot serve as a species-specific gene of E. gallinarum and that it is able to be transferred between bacteria. Although the resistance marker is not expressed in the strain, our results showed that E. faecium could acquire the vanC1gene from different species.

Vancomycin resistant Enterococcus spp (VRE): follow up during 9 years in a tertiary teaching hospital in southern Brazil

Introduction: Infection with vancomycin-resistant Enterococcus spp (VRE) has been a worldwide problem since mid 1980’s and, in Brazil, since 1996. This study was conducted to evaluate the experience with VRE in our institution. Methods: A prospective cohort study from 2000 to 2009 was conducted at Hospital São Lucas da PUCRS. All hospitalized patients with VRE positive culture were included and followed from their diagnosis until they were negative for VRE or their discharge. Only the first admission for each VRE positive patient was included. Pulsed field gel electrophoresis (PFGE) was performed to determine how VRE had spread. Results: A total of 315 cases of VRE were identified, 224 of which were isolated from rectal swabs. Vancomycin-resistant/ampicilin susceptible Enterococcus faecalis were identified in 312 isolates. PFGE was performed in 47 VRE isolates that presented an indistinguishable migratory profile. The median length of hospital stay and length of stay before VRE isolation were 46 days and 21 days, respectively; 52% of the patients were aged 60 and above. The annual distribution of the new VRE cases showed a clear decrease from 2000 to 2009. Discussion: This study shows a substantial VRE colonization (71%) with a homogenous pattern that emphasizes its transversal spread. Predominance of E. faecalis differs from the literature which largely describes a higher prevalence of vancomycin-resistant Enterococcus faecium. The follow up of VRE during 9 years in our institution highlighted the importance of continuous surveillance to prevent outbreaks in our hospital.