Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-29T07:57:03.930Z Has data issue: false hasContentIssue false
  • English
  • Français

Outbreak of Vancomycin-Resistant Enterococcus Colonization Among Pediatric Oncology Patients

Published online by Cambridge University Press:  02 January 2015

Sheila M. Nolan ,
Jeffrey S. Gerber ,
Theoklis Zaoutis ,
Priya Prasad ,
Susan Rettig ,
Kimberly Gross ,
Karin L. McGowan ,
Anne F. Reilly  and
Susan E. Coffin
Sheila M. Nolan*
Affiliation:
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Jeffrey S. Gerber
Affiliation:
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Theoklis Zaoutis
Affiliation:
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Priya Prasad
Affiliation:
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Susan Rettig
Affiliation:
Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Kimberly Gross
Affiliation:
Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Karin L. McGowan
Affiliation:
Department of Microbiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Anne F. Reilly
Affiliation:
Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
*
The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To detect the burden of vancomycin-resistant Enterococcus (VRE) colonization among pediatric oncology patients and to determine risk factors for VRE acquisition.

Design.

Retrospective case-control study.

Setting.

The Children's Hospital of Philadelphia.

Patients.

Pediatric oncology patients hospitalized from June 2006 through December 2007.

Methods.

Prevalence surveys revealed an increased VRE burden among pediatric oncology patients. For the case-control study, the 16 case patients were pediatric oncology patients who had 1 stool sample negative for VRE at screening before having a stool sample positive for VRE at screening; the 62 control patients had 2 consecutive screenings in which stool samples were negative for VRE. Case and control patients were matched on the duration of the interval between screens. Analyses were performed to determine the association between multiple exposures and VRE acquisition.

Results.

The prevalence survey revealed that 5 (9.6%) of 52 patients had unsuspected VRE colonization at the time of hospitalization. Multivariate analysis identified a lack of empirical contact precautions (odds ratio [OR], 17.16 [95% confidence interval {CI}, 1.49–198.21]; P = .02) and the presence of a gastrointestinal device (OR, 4.03 [95% CI, 1.04–15.56]; P = .04) as significant risk factors for acquisition of VRE. Observations in the interventional radiology department revealed that staff could not access the portions of the electronic medical record in which isolation precautions were documented. Simple interventions that granted access and that trained interventional radiology staff to review the need for precautions, coupled with enhanced infection control practices, interrupted ongoing transmission and reduced the proportion of VRE screens that were positive to 15 (1.2%) of 1,270.

Conclusions.

Inadequate communication with regard to infection control precautions can increase the risk of transmission of epidemiologically important organisms, particularly when patients receive care at multiple clinic locations. Adherence to infection control practices across the spectrum of care may limit the spread of resistant organisms.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 4 , April 2009 , pp. 338 - 345
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Raad, I, Hachem, R, Hanna, H, et al.Sources and outcome of bloodstream infections in cancer patients: the role of central venous catheters. Eur J Clin Microbiol Infect Dis 2007;26:549–556.CrossRefGoogle Scholar
2.Shay, DK, Maloney, SA, Montecalvo, M, et al.Epidemiology and mortality risk of vancomycin-fesistant enterococcal bloodstream infections. J Infect Dis 1995;172:993–1000.Google Scholar
3.Ostrowsky, BE, Trick, WE, Sohn, AH, et al.Control of vancomycin-resistant Enterococcus in healthcare facilities in a region. N Engl J Med 2001;344:1427–1433.Google Scholar
4.Husni, R, Hachem, R, Hanna, H, Raad, I. Risk factors for vancomycin-resistant Enterococcus (VRE) infection in colonized patients with cancer. Infect Control Hosp Epidemiol 2002;23:102–103.Google Scholar
5.Henning, KJ, Delencastre, H, Eagan, J, et al.Vancomycin-resistant Enterococcus faecium on a pediatric oncology ward: duration of stool shedding and incidence of clinical infection. Pediatr Infect Dis J 1996;15:848–854.CrossRefGoogle ScholarPubMed
6.Shay, DK, Maloney, SA, Montecalvo, M, et al.Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995;172:993–1000.Google Scholar
7.Bonten, MJ, Slaughter, S, Ambergen, AW, et al.The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:1127–1132.Google Scholar
8.Ofner-Agostini, ME, Conly, J, Paton, S, et al.Vancomycin-resistant enterococci (VRE) in Canada—results of the Canadian Nosocomial Infection Surveillance Program 1996: VRE point prevalence surveillance project. Can J Infect Dis 1997;8:73–78.Google Scholar
9.D'Agata, EM, Gautam, S, Green, WK, Tang, YW. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis 2002;34:167–172.CrossRefGoogle ScholarPubMed
10.Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: 15th informational supplement. CLSI document M100-S15. Wayne, PA: Clinical and Laboratory Standards Institute, 2005.Google Scholar
11.Sakka, V, Tsiodras, S, Galani, L, et al.Risk factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci. Clin Microbiol Infect 2008;14:14–21.Google Scholar
12.Mody, L, Maheshwari, S, Galecki, A, Kauffman, CA, Bradley, SF. Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc 2007;55:1921–1926.Google Scholar
13.Hanna, H, Umphrey, J, Tarrand, J, Mendoza, M, Raad, I. Management of an outbreak of vancomycin-resistant enterococci in the medical intensive care unit of a cancer center. Infect Control Hosp Epidemiol 2001;22:217–219.Google Scholar
14.Timmers, GJ, van der Zwet, WC, Simoons-Smit, IM, et al.Outbreak of vancomycin-resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic. Br J Haematol 2002;116:826–833.Google Scholar
15.Christiansen, KJ, Tibbett, PA, Beresford, W, et al.Eradication of a large outbreak of a single strain of vanB vancomycin-resistant Enterococcus faecium at a major Australian teaching hospital. Infect Control Hosp Epidemiol 2004;25:384–390.Google Scholar
16.Peta, M, Carretto, E, Barbarini, D, et al.Outbreak of vancomycin-resistant Enterococcus spp. in an Italian general intensive care unit. Clin Microbiol Infect 2006;12:163–169.Google Scholar
17.Schmidt-Hieber, M, Blau, IW, Schwartz, S, et al.Intensified strategies to control vancomycin-resistant enterococci in immunocompromised patients. Int J Hematol 2007;86:158–162.Google Scholar
18.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
19.NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
20.Hwang, YS, Brinton, BG, Leonard, RB, Blue, SR, Woods, ML, Carroll, KC. Investigation of an outbreak of vancomycin-resistant Enterococcus faecium in a low prevalence university hospital. J Investig Med 1998;46:435–443.Google Scholar
21.Martínez, JA, Ruthazer, R, Hansjosten, K, Barefoot, L, Snydman, DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med 2003;163:1905–1912.Google Scholar
22.Mascini, EM, Troelstra, A, Beitsma, M, et al.Genotyping and preemptive isolation to control an outbreak of vancomycin-resistant Enterococcus faecium. Clin Infect Dis 2006;42:739–746.CrossRefGoogle ScholarPubMed
23.Furtado, GH, Mendes, RE, Pignatari, AC, Wey, SB, Medeiros, EA. Risk factors for vancomycin-resistant Enterococcus faecalis bacteremia in hospitalized patients: an analysis of two case-control studies. Am J Infect Control 2006;34:447–451.Google Scholar
24.Byers, KE, Anglim, AM, Anneski, CJ, et al.A hospital epidemic of vancomycin-resistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001;22:140–147.Google Scholar
25.Chavers, LS, Moser, SA, Funkhouser, E, et al.Association between antecedent intravenous antimicrobial exposure and isolation of vancomycin-resistant enterococci. Microb Drug Resist 2003;9(Suppl 1):S69–77.CrossRefGoogle ScholarPubMed
26.Bhavnani, SM, Drake, JA, Forrest, A, et al.A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis 2000;36:145–158.Google Scholar
27.Lautenbach, E, LaRosa, LA, Marr, AM, Nachamkin, I, Bilker, WB, Fishman, NO. Changes in the prevalence of vancomycin-resistant enterococci in response to antimicrobial formulary interventions: impact of progressive restrictions on use of vancomycin and third-generation cephalosporins. Clin Infect Dis 2003;36:440–446.Google Scholar
28.Carmeli, Y, Eliopoulos, GM, Samore, MH. Antecedent treatment with different antibiotic agents as a risk factor for vancomycin-resistant Enterococcus. Emerg Infect Dis 2002;8:802–807.CrossRefGoogle ScholarPubMed
29.Fridkin, SK, Edwards, JR, Courval, JM, et al.; Intensive Care Antimicrobial Resistance Epidemiology (ICARE) Project and the National Nosocomial Infections Surveillance (NNIS) System Hospitals. The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 US adult intensive care units. Ann Intern Med 2001;135:175–183.CrossRefGoogle ScholarPubMed