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Vancomycin-Resistant Enterococci (VRE) in The Intensive Care Unit in a Nonoutbreak Setting: Identification of Potential Reservoirs and Epidemiological Associations Between Patient and Environmental VRE

Published online by Cambridge University Press:  14 December 2017

Hélène McDermott ,
Mairead Skally ,
James O’Rourke ,
Hilary Humphreys  and
Deirdre Fitzgerald-Hughes
Hélène McDermott
Affiliation:
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Center, Beaumont Hospital, Dublin. Ireland
Mairead Skally
Affiliation:
Department of Microbiology, Beaumont Hospital, Dublin, Ireland
James O’Rourke
Affiliation:
Department of Anesthesia, Beaumont Hospital, Dublin, Ireland
Hilary Humphreys
Affiliation:
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Center, Beaumont Hospital, Dublin. Ireland Department of Microbiology, Beaumont Hospital, Dublin, Ireland
Deirdre Fitzgerald-Hughes*
Affiliation:
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Center, Beaumont Hospital, Dublin. Ireland
*
Address correspondence to Dr Deirdre Fitzgerald Hughes, Department of Clinical Microbiology, RCSI Education and Research Center, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland (dfitzgeraldhughes@rcsi.ie)
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Abstract

OBJECTIVE

Among nosocomial bloodstream infections caused by enterococcal species, Ireland has the highest proportion caused by vancomycin-resistant enterococci (VRE) in Europe at 45.8%. The contribution of the near-patient environment to VRE transmission outside of outbreaks was investigated.

DESIGN

A prospective observational study was conducted during 7 sampling periods.

METHODS

Recovery of VRE isolates by swabbing the near-patient environment and patients in the intensive care unit (ICU) was conducted to identify reservoirs, clinical and molecular epidemiological associations, and the success of active surveillance cultures (ASCs).

RESULTS

Of 289 sampling occasions involving 157 patients and their bed spaces, VRE isolates were recovered from patient bed spaces, clinical samples, or both on 114 of 289 sampling occasions (39.4%). The patient and their bed space were positive for VRE on 34 of 114 VRE-associated sampling occasions (29.8%). Of 1,647 environment samples, 107 sites (6.5%) were VRE positive, with significantly greater VRE recovery from isolation rooms than from the open-plan area (9.1% vs 4.1%; P < .0001). The most frequently VRE-contaminated sites were the drip stand, bed control panel, and chart holders, which together accounted for 61% of contaminated sites. The use of ASCs resulted in a 172% increase in identification of VRE-colonized patients. Molecular typing revealed 2 environmental clusters, 1 cluster involving 3 patients and generally greater heterogeneity of patient isolates compared to environmental isolates.

CONCLUSION

Even outside of outbreaks, near-patient ICU environmental contamination with VRE is common. Better infection control policies that limit environmental transmission of VRE in the ICU and that are supported by molecular epidemiological studies, in real time, are needed.

Infect Control Hosp Epidemiol 2018;39:40–45

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 1 , January 2018 , pp. 40 - 45
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Humphreys, H. Controlling the spread of vancomycin-resistant enterococci. Is active screening worthwhile? J Hosp Infect 2014;88:191–198.Google Scholar
2. Jung, E, Byun, S, Lee, H, Moon, SY, Lee, H. Vancomycin-resistant Enterococcus colonization in the intensive care unit: clinical outcomes and attributable costs of hospitalization. Am J Infect Control 2014;42:1062–1066.Google Scholar
3. Antibiotic resistance threats in the United States. Center for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Published 2013. Accessed August 16, 2017.Google Scholar
4. European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2014. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) Stockholm; ECDC 2015.Google Scholar
5. Papadimitriou-Olivgeris, M, Drougka, E, Fligou, F, et al. Risk factors for enterococcal infection and colonization by vancomycin-resistant enterococci in critically ill patients. Infection 2014;42:1013–1022.Google Scholar
6. Boyce, JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65(Suppl 2):50–54.Google Scholar
7. Ryan, L, O’Mahony, E, Wrenn, C, et al. Epidemiology and molecular typing of VRE bloodstream isolates in an Irish tertiary care hospital. J Antimicrob Chemother 2015;70:2718–2724.Google Scholar
8. Turabelidze, D, Kotetishvili, M, Kreger, A, Morris, JG Jr, Sulakvelidze, A. Improved pulsed-field gel electrophoresis for typing vancomycin-resistant enterococci. J Clin Microbiol 2000;38:4242–4245.CrossRefGoogle ScholarPubMed
9. Ribot, EM, Fair, MA, Gautom, R, et al. Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella, and Shigella for PulseNet. Foodborne Pathog Dis 2006;3:59–67.Google Scholar
10. Goodman, ER, Platt, R, Bass, R, Onderdonk, AB, Yokoe, DS, Huang, SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593–599.CrossRefGoogle ScholarPubMed
11. Hota, B, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Interventional evaluation of environmental contamination by vancomycin-resistant enterococci: failure of personnel, product, or procedure? J Hosp Infect 2009;71:123–131.Google Scholar
12. Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:1552–1560.Google Scholar
13. Dancer, SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect 2009;73:378–385.CrossRefGoogle ScholarPubMed
14. Drees, M, Snydman, DR, Schmid, CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678–685.Google Scholar
15. Health Service Executive: Critical Care and Healthcare Associated Infection Clinical Programmes (2013). Survey of Hygiene & Healthcare Associated Infection Prevention Practices in Irish Critical Care Services Report. Health Protection Surveillance Center website. http://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hhcaisurvey2012/File,13929,en.pdf. Published 2013. Accessed May 16, 2017.Google Scholar
16. Ziakas, PD, Thapa, R, Rice, LB, Mylonakis, E. Trends and significance of VRE colonization in the ICU: a meta-analysis of published studies. PLoS One 2013;8:e75658.Google Scholar
17. Lemieux, C, Gardam, M, Evans, G, et al. Longitudinal multicenter analysis of outcomes after cessation of control measures for vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2016:1–7.Google Scholar
18. Whelton, E, Lynch, C, O’Reilly, B, et al. Vancomycin-resistant enterococci carriage in an acute Irish hospital. J Hosp Infect 2016;93:175–180.Google Scholar
19. van Schaik, W, Top, J, Riley, DR, et al. Pyrosequencing-based comparative genome analysis of the nosocomial pathogen Enterococcus faecium and identification of a large transferable pathogenicity island. BMC Genomics 2010;11:239.Google Scholar
20. Howden, BP, Holt, KE, Lam, MM, et al. Genomic insights to control the emergence of vancomycin-resistant enterococci. mBio 2013;4:e00412–e00413.Google Scholar
21. Ballard, SA, Pertile, KK, Lim, M, Johnson, PD, Grayson, ML. Molecular characterization of vanB elements in naturally occurring gut anaerobes. Antimicrob Agents Chemother 2005;49:1688–1694.Google Scholar
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