Outbreak of vancomycin-resistant Enterococcus faecium ST1133 in paediatric patients with acute lymphoblastic leukaemia from southern Brazil.

OBJECTIVES: We aimed to investigate an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) in paediatric patients from Hospital Pequeno Príncipe. The susceptibility profile was determined, and whole-genome sequencing (WGS) was used to analyse the genetic context of the strains. METHODS: Five VREfm isolates were recovered from sterile sites and surveillance cultures of two paediatric patients with acute lymphoblastic leukaemia. Species identification was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and the minimum inhibitory concentration (MIC) was assessed according to the European Committee for Antimicrobial Susceptibility Testing (EUCAST). WGS was performed to analyse the genetic context of virulence and resistance genes, and in silico multilocus sequence typing was performed to identify the sequence typing of the strains. RESULTS: High-level vancomycin resistance was observed in all isolates (≥256 mg/L). WGS revealed the presence of mobile genetic elements, such as plasmids (rep2, rep11a, repUS15, rep17, and rep18a), insertion sequences, and phages. Multiple resistance genes (aac(6')-aph(2"), dfrG, ermB, and vanA) and virulence genes (acm and efaAfm) were identified. All the isolates were assigned to ST117 (ST1133 - via a novel MLST), an important epidemic lineage associated with nosocomial infections and outbreaks. CONCLUSION: Our results show that the ST117 (ST1133) VREfm isolates are circulating in paediatric patients, which raises a great concern. The development of new drugs as well as the implementation of an antimicrobial stewardship program are necessary for their correct management, limiting the spread of resistance in oncohematological patients.

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

INTRODUCTION: Vancomycin-resistant enterococci (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 variables were identified as risk factors associated with VRE colonization: prior hospitalization in the past 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 past year (odds ratio: 5.4; 95% confidence interval: 1.5 to 18.4; p = 0.009); prior hospitalization in a high-risk area (odds ratio: 4.91; 95% confidence interval: 1.83 to 13.2; p = 0.000); hospitalization for more than five days in a 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 prior hospitalization in past 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 for intensive care with a history of prior hospitalization in the past year and exposure to two or more broad-spectrum antibiotics have a greater risk of colonization by vancomycin-resistant enterococci.

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.

An epidemiological and molecular study regarding the spread of vancomycin-resistant Enterococcus faecium in a teaching hospital in Bogotá, Colombia 2016.

BACKGROUND: Enterococcus faecium is ranked worldwide as one of the top ten pathogens identified in healthcare-associated infections (HAI) and is classified as one of the high priority pathogens for research and development of new antibiotics worldwide. Due to molecular biology techniques' higher costs, the approach for identifying and controlling infectious diseases in developing countries has been based on clinical and epidemiological perspectives. Nevertheless, after an abrupt vancomycin-resistant Enterococcus faecium dissemination in the Méderi teaching hospital, ending up in an outbreak, further measures needed to be taken into consideration. The present study describes the vancomycin-resistant Enterococcus faecium pattern within Colombian's largest installed-bed capacity hospital in 2016. METHODS: Thirty-three vancomycin-resistant Enterococcus faecium isolates were recovered during a 5-month period in 2016. Multilocus variable-number tandem-repeat analysis was used for molecular typing to determine clonality amongst strains. A modified time-place-sequence algorithm was used to trace VREfm spread patterns during the outbreak period and estimate transmission routes. RESULTS: Four clonal profiles were identified. Chronological clonal profile follow-up suggested a transitional spread from profile "A" to profile "B", returning to a higher prevalence of "A" by the end of the study. Antibiotic susceptibility indicated high-level vancomycin-resistance in most isolates frequently matching vanA gene identification. DISCUSSION: Transmission analysis suggested cross-contamination via healthcare workers. Despite epidemiological control of the outbreak, post-outbreak isolates were still being identified as having outbreak-related clonal profile (A), indicating reduction but not eradication of this clonality. This study supports the use of combined molecular and epidemiological strategies in an approach to controlling infectious diseases. It contributes towards a more accurate evaluation of the effectiveness of the epidemiological measures taken regarding outbreak control and estimates the main cause related to the spread of this microorganism.

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.

A New Kind of Quinonic-Antibiotic Useful Against Multidrug-Resistant S. aureus and E. faecium Infections.

A rapid emergence of resistant bacteria is occurring worldwide, endangering the efficacy of antibiotics and reducing the therapeutic arsenal available for treatment of infectious diseases. In the present study, we developed a new class of compounds with antibacterial activity obtained by a simple, two step synthesis and screened the products for in vitro antibacterial activity against ATCC® strains using the broth microdilution method. The compounds exhibited minimum inhibitory concentrations (MIC) of 1⁻32 µg/mL against Gram-positive ATCC® strains. The structure⁻activity relationship indicated that the thiophenol ring is essential for antibacterial activity and the substituents on the thiophenol ring module, for antibacterial activity. The most promising compounds detected by screening were tested against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VREF) clinical isolates. We found remarkable activity against VREF for compounds 7 and 16, were the MIC50/90 were 2/4 µg/mL and 4/4 µg/mL, respectively, while for vancomycin the MIC50/90 was 256/512 µg/mL. Neither compound affected cell viability in any of the mammalian cell lines at any of the concentrations tested. These in vitro data show that compounds 7 and 16 have an interesting potential to be developed as new antibacterial drugs against infections caused by VREF.

A polyclonal outbreak of bloodstream infections by Enterococcus faecium in patients with hematologic malignancies.

BACKGROUND: Enterococcus faecium causes bloodstream infection (BSI) in patients with hematologic malignancies (HMs). We studied the clinical features and outcomes of patients with HM with vancomycin-sensitive E faecium (VSE) and vancomycin-resistant E faecium (VRE) BSI and determined the genetic relatedness of isolates and circumstances associated with the upsurge of E faecium BSI. METHODS: Case-control study of patients with HM and E faecium-positive blood culture from January 2008-December 2012; cases were patients with VRE and controls were VSE isolates. The strains were tested for Van genes by polymerase chain reaction amplification and we performed pulsed-field gel electrophoresis to determine genetic relatedness. RESULTS: Fifty-eight episodes of E faecium BSI occurred: 35 sensitive and 23 resistant to vancomycin. Mortality was 46% and 57%, attributable 17% and 40%, respectively. Early stage HM was associated with VSE (P = .044), whereas an episode of BSI within the 3 months before the event (P = .039), prophylactic antibiotics (P = .013), and vancomycin therapy during the previous 3 months (P = .001) was associated with VRE. The VanA gene was identified in 97% of isolates studied. E faecium isolates were not clonal. CONCLUSIONS: E faecium BSI was associated with high mortality. This outbreak of VRE was not clonal; it was associated with antibiotic-use pressure and highly myelosuppressive chemotherapy.

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.

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.

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. .

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. Vancomycin-resistant 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 enterococci-colonized 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 vancomycin-resistant enterococci bloodstream infections.

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.

Delayed-Onset Post-Keratoplasty Endophthalmitis Caused by Vancomycin-Resistant Enterococcus faecium.

BACKGROUND: Vancomycin-resistant Enterococcus (VRE) endophthalmitis after penetrating keratoplasty (PKP) is very rare, the management is a challenge due to both the pattern of antibiotic resistance and the aggressive nature of the infectious process. We report the first delayed-onset case of VRE endophthalmitis after PKP. MATERIALS AND METHODS: Case report of a 51-year-old female with a 7-week history of PKP who arrived at the emergency room with signs and symptoms of endophthalmitis. Initial visual acuity was light perception, and a posterior pole exam was not possible due to the intense vitreous reaction. Mode B ultrasound was used to assess the posterior pole. The patient underwent pars plana vitrectomy and received intravitreous antibiotics. RESULTS: Vitreous stains and cultures were positive for Enterococcus faecium resistant to vancomycin. Donor rim cultures and viral PCR were negative. Treatment was carried out by repeated intravitreal antibiotics and systemic linezolid. Clinical improvement was seen after the second dose of intravitreous antibiotics and systemic linezolid, but visual acuity remained at light perception consistent with the ischemic changes observed in the posterior pole. CONCLUSION: VRE endophthalmitis might be associated with positive donor rim cultures. Prompt use of systemic linezolid in addition to intravitreous antibiotics is recommendable, but even with prompt treatment, visual prognosis is guarded.

Emergence and characterisation of vanB vancomycin-resistant Enterococcus faecalis in Rio de Janeiro, Brazil

Here we describe the detection and characterisation of three isolates of vancomycin-resistant VanB-type Enterococcus faecalis. Sequence analysis suggested that these isolates harboured the vanB1 gene. The isolates were susceptible to the majority of antimicrobial agents tested, with the exception of chloramphenicol, erythromycin and vancomycin, and showed distinct profiles of high-level resistance to aminoglycosides. Analysis of the clonal relatedness of the vanB E. faecalis isolates showed similar pulsed-field gel electrophoresis profiles. To our knowledge, this is the first report of the occurrence of enterococcal strains carrying vanB genes in Brazil.

Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention

The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE) outbreak in a tertiary-care pediatric intensive care unit (PICU) of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75 percent reduction), and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.

Cross-transmission of vancomycin-resistant Enterococcus in patients undergoing dialysis and kidney transplant

The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.

Estudio de factores de riesgo para colonización por enterococo resistente a vancomicina en el Hospital Militar de Santiago / Risk factors associated to vancomycin-resistant enterococccus colonization in the Army Hospital in Santiago

Since the appearance of Vancomicin-resistant enterococci (VRE) in our country, the Chilean Ministry of Health recommended the surveillance of intestinal colonization in patients in critical wards. We report the results of surveillance in ICU and onco-hematological wards from 2002 to 2008, with analysis of possible risk factors: demographical data, use and type of antibiotic, days of hospitalization prior to sampling, and year of hospitaliza-tion. Colonization rate increased from 0.03 cases per lOOObed-days in2003 to 0.18 cases during2008. Univariate analysis identified 7 risk factors associated with ERV colonization: hospitalization in ICU, use of antibiotics, use of 3 or more compounds, use of imipenem or colistin, > 10 days of hospitalization prior to the study and year of hospitalization ( before 2007 or after). Multivariate analysis by logistic binary regression showed that only the last two: >10 days of hospitalization prior to the study and year of hospitalization (before 2007 or after), were significantly associated to colonization by ERV.

Desde la emergencia de Enterococcus resistente a vancomicina (ERV) en Chile, el Ministerio de Salud recomendó la vigilancia de colonización intestinal por ERV en pacientes hospitalizados en unidades de pacientes críticos. Describimos los resultados de vigilancia en UCI y Unidad de Aislamiento de Pacientes Hemato-oncológicos desde 2002 a 2008, analizando probables factores de riesgo: datos demográficos, uso y tipo de antimicrobiano, días de hospitalización previo a la toma de muestra y año de hospitalización. La tasa de colonización aumentó de 0,03 casos por 1000 días cama en 2003 a 0,18 durante 2008. El análisis univariado permitió identificar siete factores asociados al riesgo de colonización por ERV: hospitalización en UCI, uso previo o actual de antimicrobianos, haber recibido tres o más antibióticos, terapia con imipenem o colistin, más de 10 días de hospitalización y el año de hospitalización. El análisis multivariado mediante regresión logística binaria, señaló la duración de la hospitalización hasta el momento del estudio (> 10 días) y el año de hospitalización (2007 o después) como factores significativamente asociados al riesgo de colonización por ERV.