Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit

• Authors: Ilker Devrim , Ferah Genel , Füsun Atlihan , Erhan Özbek , Gamze Gülfidan
• Languages of publication: EN

Abstracts

EN

We aimed to evaluate the risk factors for VRE colonization in neonatal intensive care units. In December 2007, we identified a neonate with VRE infection (urinary tract infection and we performed blood and stool cultures for VRE until the last colonized patient was discharged from our clinic. All the neonates hospitalized in NICU during December 2007 to January 2008. Active surveillance cultures for VRE fecal carriage was carried out in neonatal intensive care unit. Resistance to vancomycin was detected by the E-test method. Epidemiological data was recorded for all patients included in the study and was used for the risk factors. Totally 54 infants in NICU were screened for VRE colonization. Totally 11 infants (20%) were colonized with vancomycin-resistant enterococci. The average duration of all antimicrobial therapy was significantly longer in colonized patients. The infants who were hospitalized for more than 10 days were found to be significantly more colonized with VRE when compared to the infants with shorter hospital stay (p<0.05). There were no statistically significant differences between VRE colonized and non-colonized infants in respect to sex, to third generation cephalosporin usage, glycopeptide usage, presence of prematurity, presence of mechanical ventilation(p> 0.05). The premature infants and the mature infants were under risk of VRE colonization. Longer duration of hospitalization and antimicrobial usage were the prominent risk factors. Since infants in neonatal intensive care units were under risk of infections, periodic active surveillance cultures should be combined with logical antimicrobial therapy.

Keywords

EN

Vancomycin resistant enteroccocci; Neonatal intensive care unit; Colonization

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2010
• Volume: 5
• Issue: 4
• Pages: 499-503

Dates

published

1 - 8 - 2010

online

30 - 5 - 2010

Contributors

author

Ilker Devrim

• Department of Pediatrics, Behçet Uz Children’s Hospital, 90 35210, Izmir, Turkey

author

Ferah Genel

• Department of Pediatrics, Behçet Uz Children’s Hospital, 90 35210, Izmir, Turkey

author

Füsun Atlihan

• Department of Pediatrics, Behçet Uz Children’s Hospital, 90 35210, Izmir, Turkey

author

Erhan Özbek

• Department of Pediatrics, Behçet Uz Children’s Hospital, 90 35210, Izmir, Turkey

author

Gamze Gülfidan

• Department of Microbiology and Clinical Microbiology, Behçet Uz Children’s Hospital, 90 35210, Izmir, Turkey

References

• [1] Singh N, Léger MM, Campbell J, Short B, Campos JM. Control of vancomycin-resistant enterococci in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2005 Jul, 26(7), 646–649 http://dx.doi.org/10.1086/502595[Crossref]
• [2] Harbarth S., Cosgrove S., Carmeli Y. Effects of Antibiotics on Nosocomial Epidemiology of Vancomycin-Resistant Enterococci Antimicrobial Agents and Chemotherapy 2002, 46(6), 1619–1628 [PubMed][Crossref]
• [3] Nourse C., Murphy H., Byrne C. et al. Control of a nosocomial outbreak of vancomycin resistant Enterococcus faecium in a paediatric oncology unit: risk factors for colonisation Eur J Pediatr 1998, 157, 20–27 http://dx.doi.org/10.1007/s004310050760[Crossref]
• [4] MacIntyre CR, Empson M, Boardman C, Sindhusake D, Lokan J, Brown GV. Risk factors for colonization with vancomycin-resistant enterococci in a Melbourne hospital. Infect Control Hosp Epidemiol. 2001 Oct, 22(10), 624–629 http://dx.doi.org/10.1086/501833[Crossref]
• [5] Lee HK, Lee WG, Cho SR. Clinical and molecular biological analysis of a nosocomial outbreak of vancomycin-resistant enterococci in a neonatal intensive care unit. Acta Paediatr 1999, 88, 651–654 http://dx.doi.org/10.1080/08035259950169323[Crossref]
• [6] Yuce A, Karaman M, Gulay Z, Yulug N. Vancomycinresistant enterococci in neonates. Scand J Infect Dis 2001, 33, 803–805 http://dx.doi.org/10.1080/00365540110027295[Crossref]
• [7] Malik RM, Reale MR, Li K, et al. Epidemiology and control of vancomycin- resistant enterococci in a regional neonatal intensive care unit. Pediatr Infect Dis J 1999, 18, 352–356 http://dx.doi.org/10.1097/00006454-199904000-00009[Crossref]
• [8] Singh-Naz N, Sleemi A, Pikis A, Patel KM, Campos JM. Vancomycin resistant Enterococcus faecium colonization in children. J Clin Microbiol 1999, 37, 413–416
• [9] Axon RN, Engemann JJ, Butcher J, Lockamy K, Kaye KS. Control of nosocomial acquisition of vancomycin-resistant Enterococcus through active surveillance of hemodialysis patients. Infect Control Hosp Epidemiol 2004, 25, 436–438 http://dx.doi.org/10.1086/502419[Crossref]
• [10] Gordts B, Van Landuyt H, Ieven M, Vandamme P, Goossens H. Vancomycin- resistant enterococci colonizing the intestinal tracts of hospitalized patients. J Clin Microbiol 1995, 33, 2842–2846 [PubMed]
• [11] Hsueh PR, Teng LJ, Pan HJ, Chen YC, Wang LH, Chang SC et al. Emergence of vancomycinresistant enterococci at a university hospital in Taiwan: persistence of multiple species and multiple clones. Infect Control Hosp Epidemiol 1999, 20, 828–833 http://dx.doi.org/10.1086/501592[Crossref]
• [12] Bonten MJ, Hayden MK, Nathan C, van Voorhis J, Matushek M, Slaughter S et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996, 348, 1615–1619 http://dx.doi.org/10.1016/S0140-6736(96)02331-8[Crossref]
• [13] Gray JW, George RH. Experience of vancomycinresistant enterococci in a children’s hospital. J Hosp Infect 2000, 45, 11–18 http://dx.doi.org/10.1053/jhin.1999.0724[Crossref]
• [14] Noskin GA, Stosor V, Cooper I, Peterson LR. Recovery of vancomycin- resistant enterococci on fingertips and environmental surfaces. Infect Control Hosp Epidemiol 1995, 16, 577–581 http://dx.doi.org/10.1086/647011[Crossref]
• [15] Noskin GA, Bednarz P, Suriano T, Reiner S, Peterson LR. Persistent contamination of fabriccovered furniture by vancomycin-resistant enterococci: implications for upholstery selection in hospitals. Am J Infect Control 2000, 28, 311–313 http://dx.doi.org/10.1067/mic.2000.108129[Crossref]
• [16] McNeely DF, Saint-Louis F, Noel GJ. Neonatal enterococcal bacteremia: an increasingly frequent event with potentially untreatable pathogens. Pediatr Infect Dis J 1996, 15, 800–805 http://dx.doi.org/10.1097/00006454-199609000-00013[Crossref]
• [17] Hancock LE, Gilmore MS.Pathogenicity of Enterococci. In: Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA, Rood JI (eds), Gram-Positive Pathogens, ASM Press, Washington D.C., p.251–258
• [18] Moellering RC Jr. Vancomycin-resistant enterococci. Clin Infect Dis 1998, 26, 1196–1199 http://dx.doi.org/10.1086/520283[Crossref]
• [19] Colak D, Naas T, Gunseren F, Fortineau N, Ogunc D, Gultekin M et al First outbreak of vancomycinresistant enterococci in a tertiary hospital in Turkey. Journal of Antimicrobial Chemotherapy 2002, 50, 397–401 http://dx.doi.org/10.1093/jac/dkf134[Crossref]
• [20] Hufnagel M, Liese C, Loescher C, Kunze M, Proempeler H, Berner R et al. Enterococcal colonization of infants in a neonatal intensive care unit: associated predictors, risk factors and seasonal patterns. BMC Infect Dis. 2007, 7, 107 http://dx.doi.org/10.1186/1471-2334-7-107[WoS][Crossref]
• [21] Mackie RI, Sghir A, Gaskin HR: Developmental microbial ecology of the neonatal gastrointestinal tract. Am J Clin Nutr 1999, 69(Suppl), 1035S–1045S
• [22] Schwiertz A, Gruhl B, Löbnitz M, Michel P, Radke P, Blaut M: Development of the intestinal bacterial composition in hospitalized preterm infants in comparison with breast-fed, fullterm infants. Pediatr Res 2003, 54, 393–399 http://dx.doi.org/10.1203/01.PDR.0000078274.74607.7A[Crossref]
• [23] Orrhage K, Nord CE: Factors controlling the bacterial colonization of the intestine in breastfed infants. Acta Paediatr Suppl 1999, 430, 47–57
• [24] Jimenez E, Fernandez L, Marin ML, Martin R, Odriozola JM, Nueno-Palop C et al. Isolation of commensal bacteria from umbilical cord blood of healthy neonates born by cesarean section. Curr Microbiol 2005, 51, 270–274 http://dx.doi.org/10.1007/s00284-005-0020-3[Crossref]
• [25] Furtado GH, Mendes RE, Pignatari ACC, Wey SB, Medeiros EAS. Risk factors for vancomycinresistant Enterococcus faecalis bacteremia in hospitalized patients: an analysis of two casecontrol studies. Am J Infect Control 2006, 34, 447–451 http://dx.doi.org/10.1016/j.ajic.2005.08.015[Crossref]
• [26] Fridkin SK, Edwards JR, Courval JM, Hill H, Tenover FC, Lawton R et al. The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units. Ann Intern Med 2001, 135, 175–183
• [27] Huh JY, Lee WG, Jin HY. Molecular characterization of vancomycin resistant enterococci from clinical and surveillance specimens. Infect Control Hosp Epidemiol 2006, 27, 1076–1080 http://dx.doi.org/10.1086/507961[Crossref]
• [28] C. Nourse, H. Murphy, C. Byrne, A. O’Meara, F. Breatnach, M. Kaufmann A et al. Control of a nosocomial outbreak of vancomycin resistant Enterococcus faeciumin a paediatric oncology unit: risk factors for colonisation Eur J Pediatr 1998, 157, 20–27 http://dx.doi.org/10.1007/s004310050760[Crossref]
• [29] Fanaro S, Chierici R, Guerrini P, Vigi V: Intestinal microflora in early infancy: composition and development. Acta Paediatr Suppl 2003, 441, 48–55
• [30] Orrhage K, Nord CE: Factors controlling the bacterial colonization of the intestine in breastfed infants. Acta Paediatr Suppl 1999, 430, 47–57
• [31] Carmeli, Y., M. H. Samore, C. Huskins. The association between antecedent vancomycin treatment and hospital-acquired vancomycinresistant enterococci: a meta-analysis. Arch. Intern. Med. 1999, 159, 2461–2468 http://dx.doi.org/10.1001/archinte.159.20.2461[Crossref]
• [32] Edmond MB, Ober JF, Weinbaum DL, Pfaller MA, Hwang T, Sanford MD et al. Vancomycin-Resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995, 20, 1126–1133 [Crossref]
• [33] Gordts B, Van Landuyt H, Ieven M, Vandamme P, Goossens H Vancomycin-resistant enterococci colonizing the intestinal tracts of hospitalized patients. J Clin Microbiol 1995, 33, 2842–2846 [PubMed]
• [34] Montecalvo MA, Horowitz H, Gedris C, Carbonaro C, Tenover FC, Issah A et al. Outbreak of vancomycin-, ampicillin-, and aminoglycosideresistant Enterococcus faecium bacteremia in an adult oncology unit. J.Antimicrob Chemother 1994, 38(6), 1363–1367 [Crossref]
• [35] Shay DK, Maloney SA, Montecalvo M, Banerjee S, Wormser GP, Arduino MJ et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995, 172, 993–1000
• [36] Rubin LG, Tucci V, Cercenado E, Eliopoulos G, Isenberg HD Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992, 13, 700–705 http://dx.doi.org/10.1086/648342[Crossref]
• [37] Miedema CJ, Kerkhof M, Arends JP, Bergman KA, Kimpen JLL: Risk factors for colonization with enterococci in a neonatal intensive care unit. Clin Microbiol Infect 2000, 6, 53 http://dx.doi.org/10.1046/j.1469-0691.2000.00019.x[Crossref]

Identifiers

DOI

10.2478/s11536-009-0073-y