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Vancomycin-resistant Enterococcus (VRE) outbreak in a neonatal intensive care unit and special care nursery at a tertiary-care hospital in Australia—A retrospective case-control study

Published online by Cambridge University Press:  14 March 2019

Patiyan Andersson Open the ORCID record for Patiyan Andersson [Opens in a new window] ,
Wendy Beckingham ,
Claire Louise Gorrie ,
Karina Kennedy ,
Kathryn Daveson ,
Susan Alicia Ballard ,
Ming Chen ,
Katrina Roper  and
Nicholas Coatsworth
Patiyan Andersson*
Affiliation:
National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
Wendy Beckingham
Affiliation:
Infection Prevention and Control, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia
Claire Louise Gorrie
Affiliation:
Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
Karina Kennedy
Affiliation:
Infectious Disease and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
Kathryn Daveson
Affiliation:
Infectious Disease and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
Susan Alicia Ballard
Affiliation:
Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
Ming Chen
Affiliation:
Infectious Disease and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia
Katrina Roper
Affiliation:
National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
Nicholas Coatsworth
Affiliation:
Infectious Disease and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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Abstract

Objective:

We investigated the risk factors and origins of the first known occurrence of VRE colonization in the neonatal intensive care unit (NICU) at the Canberra Hospital.

Design:

A retrospective case-control study.

Setting:

A 21-bed neonatal intensive care unit (NICU) and a 15-bed special care nursey (SCN) in a tertiary-care adult and pediatric hospital in Australia.

Patients:

All patients admitted to the NICU and SCN over the outbreak period: January–May 2017. Of these, 14 were colonized with vancomycin-resistant Enterococcus (VRE) and 77 were noncolonized.

Methods:

Demographic and clinical variables of cases and controls were compared to evaluate potential risk factors for VRE colonization. Whole-genome sequencing of the VRE isolates was used to determine the origin of the outbreak strain.

Results:

Swift implementation of wide-ranging infection control measures brought the outbreak under control. Multivariate logistic regression revealed a strong association between early gestational age and VRE colonization (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.94–7.00). Whole-genome sequencing showed the isolates to be highly clonal Enterococcus faecium ST1421 harboring a vanA gene and to be closely related to other ST1421 previously sequenced from the Canberra Hospital and the Australian Capital Territory.

Conclusion:

The colonization of NICU patients was with a highly successful clone endemic to the Canberra Hospital likely introduced into the NICU environment from other wards, with subsequent cross-contamination spreading among the neonate patients. Use of routine surveillance screening may have identified colonization at an earlier stage and have now been implemented on a 6-monthly schedule.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 5 , May 2019 , pp. 551 - 558
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

Satilmis, L, Vanhems, P, Benet, T. Outbreaks of vancomycin-resistant enterococci in hospital settings: a systematic review and calculation of the basic reproductive number. Infect Control Hosp Epidemiol 2016;37:289–294.CrossRefGoogle ScholarPubMed
Akturk, H, Sutcu, M, Somer, A, et al. Vancomycin-resistant enterococci colonization in a neonatal intensive care unit: who will be infected? J Matern Fetal Neonatal Med 2016;29:3478–3482.Google Scholar
Flokas, ME, Karageorgos, SA, Detsis, M, Alevizakos, M, Mylonakis, E. Vancomycin-resistant enterococci colonisation, risk factors and risk for infection among hospitalised paediatric patients: a systematic review and meta-analysis. Int J Antimicrob Agents 2017;49:565–572.CrossRefGoogle ScholarPubMed
Kara, A, Devrim, I, Bayram, N, et al. Risk of vancomycin-resistant enterococci bloodstream infection among patients colonized with vancomycin-resistant enterococci. Braz J Infect Dis 2015;19:58–61.CrossRefGoogle ScholarPubMed
Khan, AM, Morris, SK, Bhutta, ZA. Neonatal and perinatal infections. Pediatr Clin N Am 2017;64:785–798.CrossRefGoogle ScholarPubMed
Iosifidis, E, Evdoridou, I, Agakidou, E, et al. Vancomycin-resistant Enterococcus outbreak in a neonatal intensive care unit: epidemiology, molecular analysis and risk factors. Am J Infect Control 2013;41:857–861.CrossRefGoogle Scholar
Malik, RK, Montecalvo, MA, Reale, MR, et al. Epidemiology and control of vancomycin-resistant enterococci in a regional neonatal intensive care unit. Pediatr Infect Dis J. 1999;18:352–356.CrossRefGoogle Scholar
Croucher, NJ, Page, AJ, Connor, TR, et al. Rapid phylogenetic analysis of large samples of recombinant bacterial whole genome sequences using Gubbins. Nucleic Acids Res 2015;43(3):e15.CrossRefGoogle ScholarPubMed
Nguyen, LT, Schmidt, HA, von Haeseler, A, Minh, BQ. IQ-TREE: a fast and effective stochastic algorithm for estimating maximum-likelihood phylogenies. Mol Biol Evol 2015;32:268–274.CrossRefGoogle ScholarPubMed
Guindon, S, Dufayard, JF, Lefort, V, Anisimova, M, Hordijk, W, Gascuel, O. New algorithms and methods to estimate maximum-likelihood phylogenies: assessing the performance of PhyML 3.0. Syst Biol 2010;59:307–321.CrossRefGoogle ScholarPubMed
Minh, BQ, Nguyen, MA, von Haeseler, A. Ultrafast approximation for phylogenetic bootstrap. Mol Biol Evol 2013;30:1188–1195.CrossRefGoogle ScholarPubMed
Pusch, T, Kemp, D, Trevino, S, et al. Controlling outbreak of vancomycin-resistant Enterococcus faecium among infants caused by an endemic strain in adult inpatients. Am J Infect Control 2013;41:51–56.CrossRefGoogle ScholarPubMed
Hufnagel, M, Liese, C, Loescher, C, 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.CrossRefGoogle Scholar
Miedema, CJ, Kerkhof, M, Arends, JP, Bergman, KA, Kimpen, JL. Risk factors for colonization with enterococci in a neonatal intensive care unit. Clin Microbiol Infect 2000;6:53.CrossRefGoogle Scholar
Tanyeri-Bayraktar, B, Bayraktar, S. Vancomycin-resistant enterococci colonization in a neonatal intensive care unit: case-control study. J Clin Anal Med 2017;8:276–279.Google Scholar
Yuce, A, Karaman, M, Gulay, Z, Yulug, N. Vancomycin-resistant enterococci in neonates. Scand J Infect Dis 2001;33:803–805.Google ScholarPubMed
Devrim, I, Genel, F, Atlihan, F, Özbek, E, Gülfidan, G. Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit. Centr Eur J Med 2010;5:499–503.Google Scholar
Khan, E, Sarwari, A, Hasan, R, et al. Emergence of vancomycin-resistant Enterococcus faecium at a tertiary-care hospital in Karachi, Pakistan. J Hosp Infect 2002;52:292–296.CrossRefGoogle Scholar
Drell, T, Lutsar, I, Stsepetova, J, et al. The development of gut microbiota in critically ill extremely low birth weight infants assessed with 16S rRNA gene-based sequencing. Gut Microbes 2014;5:304–312.CrossRefGoogle ScholarPubMed
Fanaro, S, Chierici, R, Guerrini, P, Vigi, V. Intestinal microflora in early infancy: composition and development. Acta Paediatr Supp 2003;91:48–55.Google ScholarPubMed
Gewolb, IH, Schwalbe, RS, Taciak, VL, Harrison, TS, Panigrahi, P. Stool microflora in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed 1999;80:F167–F173.CrossRefGoogle ScholarPubMed
Jacquot, A, Neveu, D, Aujoulat, F, et al. Dynamics and clinical evolution of bacterial gut microflora in extremely premature patients. J Pediatr 2011;158:390–396.CrossRefGoogle ScholarPubMed
Patel, AL, Mutlu, EA, Sun, Y, et al. Longitudinal survey of microbiota in hospitalized preterm very-low-birth-weight infants. J Pediatr Gastroenterol Nutr 2016;62:292–303.CrossRefGoogle ScholarPubMed
Madan, JC, Salari, RC, Saxena, D, et al. Gut microbial colonisation in premature neonates predicts neonatal sepsis. Arch Dis Child Fetal Neonatal Ed 2012;97:F456–F462.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
Knelson, LP, Williams, DA, Gergen, MF, et al. A comparison of environmental contamination by patients infected or colonized with methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci: a multicenter study. Infect Control Hosp Epidemiol 2014;35:872–875.CrossRefGoogle ScholarPubMed
Kramer, A, Schwebke, I, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130.CrossRefGoogle Scholar
Otter, JA, Yezli, S, Salkeld, JA, French, GL. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control 2013;41(5 Suppl):S6–S11.CrossRefGoogle ScholarPubMed
van Hal, SJ, Espedido, BA, Coombs, GW, et al. Polyclonal emergence of vanA vancomycin-resistant Enterococcus faecium in Australia. J Antimicrob Chemother 2017;72:998–1001.Google ScholarPubMed
Coombs, GW, Daley, DA, Thin Lee, Y, et al. Australian Group on Antimicrobial Resistance Australian Enterococcal Sepsis Outcome Programme annual report, 2014. Commun Dis Intell Q Rep 2016;40:E236–E243.Google Scholar
Carter, GP, Buultjens, AH, Ballard, SA, et al. Emergence of endemic MLST non-typeable vancomycin-resistant Enterococcus faecium. J Antimicrob Chemother 2016;71:3367–3371.CrossRefGoogle ScholarPubMed
Ergaz, Z, Arad, I, Bar-Oz, B, et al. Elimination of vancomycin-resistant enterococci from a neonatal intensive care unit following an outbreak. J Hosp Infect 2010;74:370–376.CrossRefGoogle ScholarPubMed
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