 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 August 1995 | Volume 123 Issue 4 | Pages 250-259
Objectives: To determine the distribution of and risk factors for colonization and infection with vancomycin-resistant enterococci; to evaluate the molecular epidemiology of these strains; and to assess the effect of interventions, including 1) strict adherence to infection control procedures and 2) restricted use of vancomycin.
Design: Problem identification based on descriptive studies, point-prevalence surveys, and case–control studies and followed by specific interventions and evaluation of the response to these interventions.
Setting: University medical center.
Participants: All patients hospitalized between May 1992 and June 1994 (59 196 admissions).
Main Results: 75 active infections attributed to vancomycin-resistant enterococci were identified. Thirty-one patients (41%) had bloodstream infections and 6 (8%) died. The incidence of active infection was highest in the organ transplantation unit (13.2 infections/1000 admissions). In the point-prevalence studies, vancomycin-resistant enterococci were isolated from 20% of a random sample of hospitalized patients in July, August, and September 1993 [adjusted prevalence, 16.9%]. Case-control studies showed significant associations between colonization and infection and 1) receipt of antimicrobial agents, particularly vancomycin, and 2) severity of illness. Although several small case clusters had isolates with identical banding patterns on pulsed-field gel electrophoresis, at least 45 different banding patterns were noted among medical center isolates. Interventions took place in November and December 1993. Vancomycin restriction policies resulted in a 59% decrease in intravenous vancomycin use and an 85% decrease in oral vancomycin use. Point-prevalence surveys done in April, May, and June 1994 showed a consistent 20% level of colonization with vancomycin-resistant enterococci strains (adjusted prevalence, 18.7%). No significant changes were seen in rates of vancomycin-resistant enterococci infection.
Conclusions: Vancomycin-resistant enterococci are an important cause of illness and death in the study institution, particularly among organ transplant recipients and other seriously ill persons; they have also become a common intestinal colonizer among hospitalized patients. The diversity of isolates (based on molecular typing studies) suggests that resistant organisms have been introduced from multiple sources. Interventions that effectively lower the overall level of colonization with vancomycin-resistant enterococci must still be identified.
Author and Article Information
From the University of Maryland School of Medicine and Veterans Affairs Medical Center, Baltimore, Maryland. The Centers for Disease Control and Prevention, Atlanta, Georgia.
ARTICLE
Enterococci Resistant to Multiple Antimicrobial Agents, Including Vancomycin: Establishment of Endemicity in a University Medical Center
Requests for Reprints: J. Glenn Morris Jr., MD, Infectious Diseases Section, Baltimore Veterans Affairs Medical Center, 10 North Greene Street, Baltimore, MD 21201.
Acknowledgments: The authors thank Sadaf Qaiyumi, Teheri Laskerwala, Marcia Fullem, Punam R. Verma, Tracy Harrison, Michael Ann Priess, and the staff of the University of Maryland School of Medicine Clinical Microbiology Laboratory for their technical assistance in this study; Kim Homes for assistance with chart review and collection of epidemiologic data; Michael J. Orsini and Drs. Paul J. Weidle and Joseph Gallina for establishing and monitoring compliance with the vancomycin restrictions and for collecting pharmacy data; Sonia Aguero and Dr. Matthew Arduino for hand-culturing studies; and Drs. Harold Standiford and Steve Schimpff for their thoughtful comments on the manuscript.
This article has been cited by other articles:
|
|
 |
|
  P. M. Hawkey The growing burden of antimicrobial resistance J. Antimicrob. Chemother., September 1, 2008; 62(suppl_1): i1 - i9. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Bailey and K. M. Summers Dalbavancin: A new lipoglycopeptide antibiotic Am. J. Health Syst. Pharm., April 1, 2008; 65(7): 599 - 610. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Rice, L. L. Carias, S. Rudin, V. Lakticova, A. Wood, and R. Hutton-Thomas Enterococcus faecium Low-Affinity pbp5 Is a Transferable Determinant Antimicrob. Agents Chemother., December 1, 2005; 49(12): 5007 - 5012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. P. Currie and L. Lemos-Filho Evidence for Biliary Excretion of Vancomycin into Stool during Intravenous Therapy: Potential Implications for Rectal Colonization with Vancomycin-Resistant Enterococci Antimicrob. Agents Chemother., November 1, 2004; 48(11): 4427 - 4429. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Silvestri, H.K.F. van Saene, M. Milanese, F. Fontana, D. Gregori, L. Oblach, N. Piacente, and M. Blazic Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial Eur. Respir. J., June 1, 2004; 23(6): 921 - 926. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. F. Oprea, N. Zaidi, S. M. Donabedian, M. Balasubramaniam, E. Hershberger, and M. J. Zervos Molecular and clinical epidemiology of vancomycin-resistant Enterococcus faecalis J. Antimicrob. Chemother., April 1, 2004; 53(4): 626 - 630. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. McMahon, T. W. Hennessy, J. M. Bensler, D. L. Bruden, A. J. Parkinson, J. M. Morris, A. L. Reasonover, D. A. Hurlburt, M. G. Bruce, F. Sacco, et al. The Relationship among Previous Antimicrobial Use, Antimicrobial Resistance, and Treatment Outcomes for Helicobacter pylori Infections Ann Intern Med, September 16, 2003; 139(6): 463 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Martinez, R. Ruthazer, K. Hansjosten, L. Barefoot, and D. R. Snydman 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, September 8, 2003; 163(16): 1905 - 1912. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Gelsomino, M. Vancanneyt, T. M. Cogan, and J. Swings Effect of Raw-Milk Cheese Consumption on the Enterococcal Flora of Human Feces Appl. Envir. Microbiol., January 1, 2003; 69(1): 312 - 319. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Safdar and D. G. Maki The Commonality of Risk Factors for Nosocomial Colonization and Infection with Antimicrobial-Resistant Staphylococcus aureus, Enterococcus, Gram-Negative Bacilli, Clostridium difficile, and Candida Ann Intern Med, June 4, 2002; 136(11): 834 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Harbarth, S. Cosgrove, and Y. Carmeli Effects of Antibiotics on Nosocomial Epidemiology of Vancomycin-Resistant Enterococci Antimicrob. Agents Chemother., June 1, 2002; 46(6): 1619 - 1628. [Full Text] [PDF]
|
|
|
|
|
|
T. R. Licht, D. Laugesen, L. B. Jensen, and B. L. Jacobsen Transfer of the Pheromone-Inducible Plasmid pCF10 among Enterococcus faecalis Microorganisms Colonizing the Intestine of Mini-Pigs Appl. Envir. Microbiol., January 1, 2002; 68(1): 187 - 193. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Dancer The problem with cephalosporins J. Antimicrob. Chemother., October 1, 2001; 48(4): 463 - 478. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Leibovici, R. Berger, T. Gruenewald, J. Yahav, Y. Yehezkelli, G. Milo, M. Paul, Z. Samra, and S. D. Pitlik Departmental consumption of antibiotic drugs and subsequent resistance: a quantitative link J. Antimicrob. Chemother., October 1, 2001; 48(4): 535 - 540. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Roger, P. St.-Antoine, F. Coutlee, B. Ostrowsky, and W. Jarvis Vancomycin-Resistant Enterococci in Health Care Facilities N. Engl. J. Med., September 6, 2001; 345(10): 768 - 769. [Full Text] [PDF]
|
|
|
|
|
|
S. K. Fridkin, J. R. Edwards, J. M. Courval, H. Hill, F. C. Tenover, R. Lawton, R. P. Gaynes, J. E. McGowan Jr., and for the Intensive Care Antimicrobial Resistance Ep 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, August 7, 2001; 135(3): 175 - 183. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. MIYAZAKI, T. FUJIKAWA, I. KOBAYASHI, T. MATSUMOTO, K. TATEDA, and K. YAMAGUCHI Development of systemic bacteraemia after oral inoculation of vancomycin-resistant enterococci in mice J. Med. Microbiol., August 1, 2001; 50(8): 695 - 701. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. E. Ostrowsky, W. E. Trick, A. H. Sohn, S. B. Quirk, S. Holt, L. A. Carson, B. C. Hill, M. J. Arduino, M. J. Kuehnert, and W. R. Jarvis Control of Vancomycin-Resistant Enterococcus in Health Care Facilities in a Region N. Engl. J. Med., May 10, 2001; 344(19): 1427 - 1433. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Trakulsomboon, S. Danchaivijitr, Y. Rongrungruang, C. Dhiraputra, W. Susaemgrat, T. Ito, and K. Hiramatsu First Report of Methicillin-Resistant Staphylococcus aureus with Reduced Susceptibility to Vancomycin in Thailand J. Clin. Microbiol., February 1, 2001; 39(2): 591 - 595. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. E. Patterson Antibiotic Utilization : Is There an Effect on Antimicrobial Resistance? Chest, February 1, 2001; 119(2_suppl): 426S - 430S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Donskey, T. K. Chowdhry, M. T. Hecker, C. K. Hoyen, J. A. Hanrahan, A. M. Hujer, R. A. Hutton-Thomas, C. C. Whalen, R. A. Bonomo, and L. B. Rice Effect of Antibiotic Therapy on the Density of Vancomycin-Resistant Enterococci in the Stool of Colonized Patients N. Engl. J. Med., December 28, 2000; 343(26): 1925 - 1932. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Mundy, D. F. Sahm, and M. Gilmore Relationships between Enterococcal Virulence and Antimicrobial Resistance Clin. Microbiol. Rev., October 1, 2000; 13(4): 513 - 522. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Cetinkaya, P. Falk, and C. G. Mayhall Vancomycin-Resistant Enterococci Clin. Microbiol. Rev., October 1, 2000; 13(4): 686 - 707. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Chen, L. Pearce, A. McGeer, D. E. Low, and B. M. Willey Evaluation of D-Xylose and 1% Methyl-alpha -D-Glucopyranoside Fermentation Tests for Distinguishing Enterococcus gallinarum from Enterococcus faecium J. Clin. Microbiol., October 1, 2000; 38(10): 3652 - 3655. [Abstract] [Full Text]
|
|
|
|
|
|
C. A. Manthous and Y. Amoateng-Adjepong Empiric Antibiotic Use and Resistant Microbes : A "Catch-22" for the 21st Century Chest, July 1, 2000; 118(1): 9 - 11. [Full Text] [PDF]
|
|
|
|
|
|
B. E. Murray Vancomycin-Resistant Enterococcal Infections N. Engl. J. Med., March 9, 2000; 342(10): 710 - 721. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Lipsitch, C. T. Bergstrom, and B. R. Levin From the Cover: The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions PNAS, February 15, 2000; 97(4): 1938 - 1943. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Gambarotto, M.-C. Ploy, P. Turlure, C. Grélaud, C. Martin, D. Bordessoule, and F. Denis Prevalence of Vancomycin-Resistant Enterococci in Fecal Samples from Hospitalized Patients and Nonhospitalized Controls in a Cattle-Rearing Area of France J. Clin. Microbiol., February 1, 2000; 38(2): 620 - 624. [Abstract] [Full Text]
|
|
|
|
|
|
A. von Gottberg, W. van Nierop, A. Dusé, M. Kassel, K. McCarthy, A. Brink, M. Meyers, R. Smego, and H. Koornhof Epidemiology of Glycopeptide-Resistant Enterococci Colonizing High-Risk Patients in Hospitals in Johannesburg, Republic of South Africa J. Clin. Microbiol., February 1, 2000; 38(2): 905 - 909. [Abstract] [Full Text]
|
|
|
|
|
|
W. E. Bischoff, T. M. Reynolds, G. O. Hall, R. P. Wenzel, and M. B. Edmond Molecular Epidemiology of Vancomycin-Resistant Enterococcus faecium in a Large Urban Hospital over a 5-Year Period J. Clin. Microbiol., December 1, 1999; 37(12): 3912 - 3916. [Abstract] [Full Text]
|
|
|
|
|
|
Y. Carmeli, M. H. Samore, and W. C. Huskins The Association Between Antecedent Vancomycin Treatment and Hospital-Acquired Vancomycin-Resistant Enterococci: A Meta-analysis Arch Intern Med, November 8, 1999; 159(20): 2461 - 2468. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Daubener, C. Hucke, K. Seidel, U. Hadding, and C. R. MacKenzie Interleukin-1 Inhibits Gamma Interferon-Induced Bacteriostasis in Human Uroepithelial Cells Infect. Immun., November 1, 1999; 67(11): 5615 - 5620. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Roger, M.-C. Faucher, P. Forest, P. St-Antoine, and F. Coutlée Evaluation of a vanA-Specific PCR Assay for Detection of Vancomycin-Resistant Enterococcus faecium during a Hospital Outbreak J. Clin. Microbiol., October 1, 1999; 37(10): 3348 - 3349. [Abstract] [Full Text]
|
|
|
|
|
|
M. A. Montecalvo, W. R. Jarvis, J. Uman, D. K. Shay, C. Petrullo, K. Rodney, C. Gedris, H. W. Horowitz, and G. P. Wormser Infection-Control Measures Reduce Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting Ann Intern Med, August 17, 1999; 131(4): 269 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. E. Ostrowsky, L. Venkataraman, E. M. C. D'Agata, H. S. Gold, P. C. DeGirolami, and M. H. Samore Vancomycin-Resistant Enterococci in Intensive Care Units: High Frequency of Stool Carriage During a Non-Outbreak Period Arch Intern Med, July 12, 1999; 159(13): 1467 - 1472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Leibovici, I. Shraga, S. Andreassen, S. G Pauker, M. Rothberg, J. R Weinberg, B. I Duerden, and M. A Drickamer How do you choose antibiotic treatment? • Commentary: Resist jumping to conclusions • Commentary: A matter of good clinical practice • Commentary: Honesty is the best policy BMJ, June 12, 1999; 318(7198): 1614 - 1618. [Full Text]
|
|
|
|
|
|
D. J. Austin, M. J. M. Bonten, R. A. Weinstein, S. Slaughter, and R. M. Anderson Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programs PNAS, June 8, 1999; 96(12): 6908 - 6913. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. L. Willems, J. Top, N. van den Braak, A. van Belkum, D. J. Mevius, G. Hendriks, M. van Santen-Verheuvel, and J. D. A. van Embden Molecular Diversity and Evolutionary Relationships of Tn1546-Like Elements in Enterococci from Humans and Animals Antimicrob. Agents Chemother., March 1, 1999; 43(3): 483 - 491. [Abstract] [Full Text]
|
|
|
|
|
|
K. L. Hanson and C. P. Cartwright Comparison of Simple and Rapid Methods for Identifying Enterococci Intrinsically Resistant to Vancomycin J. Clin. Microbiol., March 1, 1999; 37(3): 815 - 817. [Abstract] [Full Text]
|
|
|
|
|
|
J. Huebner, Y. Wang, W. A. Krueger, L. C. Madoff, G. Martirosian, S. Boisot, D. A. Goldmann, D. L. Kasper, A. O. Tzianabos, and G. B. Pier Isolation and Chemical Characterization of a Capsular Polysaccharide Antigen Shared by Clinical Isolates of Enterococcus faecalis and Vancomycin-Resistant Enterococcus faecium Infect. Immun., March 1, 1999; 67(3): 1213 - 1219. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ostrowsky and G. M. Eliopoulos Analytic Reviews : Enterococcal Infections: Resistance Mechanisms, Treatment Strategies, and Hospital Issues: Ostrowsky B, Eliopoulos, GM Enterococcal Infections Resistance Mechanisms, Treatment Strategies, and Hospital Issues J Intensive Care Med 1999,14.62-73 J Intensive Care Med, March 1, 1999; 14(2): 62 - 73. [PDF]
|
|
|
|
|
|
S. J. Bradley, A. L. T. Wilson, M. C. Allen, H. A. Sher, A. H. Goldstone, and G. M. Scott The control of hyperendemic glycopeptide-resistant Enterococcus spp. on a haematology unit by changing antibiotic usage J. Antimicrob. Chemother., February 1, 1999; 43(2): 261 - 266. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Singh-Naz, A. Sleemi, A. Pikis, K. M. Patel, and J. M. Campos Vancomycin-Resistant Enterococcus faecium Colonization in Children J. Clin. Microbiol., February 1, 1999; 37(2): 413 - 416. [Abstract] [Full Text]
|
|
|
|
|
|
C. Wendt, B. Wiesenthal, E. Dietz, and H. Rüden Survival of Vancomycin-Resistant and Vancomycin-Susceptible Enterococci on Dry Surfaces J. Clin. Microbiol., December 1, 1998; 36(12): 3734 - 3736. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. A. Dahms, E. M. Johnson, C. L. Statz, J. T. Lee, D. L. Dunn, and G. J. Beilman Third-Generation Cephalosporins and Vancomycin as Risk Factors for Postoperative Vancomycin-Resistant Enterococcus Infection Arch Surg, December 1, 1998; 133(12): 1343 - 1346. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. G. Shojania, D. Yokoe, R. Platt, J. Fiskio, N. Ma'luf, and D. W. Bates Reducing Vancomycin Use Utilizing a Computer Guideline: Results of a Randomized Controlled Trial J. Am. Med. Inform. Assoc., November 1, 1998; 5(6): 554 - 562. [Abstract] [Full Text]
|
|
|
|
 |
|
 L. L. Carias, S. D. Rudin, C. J. Donskey, and L. B. Rice Genetic Linkage and Cotransfer of a Novel, vanB-Containing Transposon (Tn5382) and a Low-Affinity Penicillin-Binding Protein 5 Gene in a Clinical Vancomycin-Resistant Enterococcus faecium Isolate J. Bacteriol., September 1, 1998; 180(17): 4426 - 4434. [Abstract] [Full Text]
|
|
|
|
|
|
S. K. Fridkin, D. S. Yokoe, C. G. Whitney, A. Onderdonk, and D. C. Hooper Epidemiology of a Dominant Clonal Strain of Vancomycin-Resistant Enterococcus faecium at Separate Hospitals in Boston, Massachusetts J. Clin. Microbiol., April 1, 1998; 36(4): 965 - 970. [Abstract] [Full Text]
|
|
|
|
|
|
F. C. Tenover, M. V. Lancaster, B. C. Hill, C. D. Steward, S. A. Stocker, G. A. Hancock, C. M. O'Hara, N. C. Clark, and K. Hiramatsu Characterization of Staphylococci with Reduced Susceptibilities to Vancomycin and Other Glycopeptides J. Clin. Microbiol., April 1, 1998; 36(4): 1020 - 1027. [Abstract] [Full Text]
|
|
|
|
|
|
V. Stosor, L. R. Peterson, M. Postelnick, and G. A. Noskin Enterococcus faecium Bacteremia: Does Vancomycin Resistance Make a Difference? Arch Intern Med, March 9, 1998; 158(5): 522 - 527. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Slaughter, M. K. Hayden, C. Nathan, T.-C. Hu, T. Rice, J. Van Voorhis, M. Matushek, C. Franklin, and R. A. Weinstein A Comparison of the Effect of Universal Use of Gloves and Gowns with That of Glove Use Alone on Acquisition of Vancomycin-Resistant Enterococci in a Medical Intensive Care Unit Ann Intern Med, September 15, 1996; 125(6): 448 - 456. [Abstract] [Full Text]
|
|
Article
