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Colonization With Vancomycin-Resistant Enterococcus faecium Comparison of a Long-Term–Care Unit With an Acute-Care Hospital

Published online by Cambridge University Press:  02 January 2015

Hector F. Bonilla ,
Marcus A. Zervos ,
Michael J. Lyons ,
Suzanne F. Bradley ,
Sara A. Hedderwick ,
Mary A. Ramsey ,
Laura K. Paul  and
Carol A. Kauffman
Hector F. Bonilla
Affiliation:
Divisions of Infectious Diseases and Geriatric Medicine, Department of Internal Medicine, Veterans' Affairs Medical Center, University of Michigan Medical School, Ann Arbor, Michigan
Marcus A. Zervos
Affiliation:
William E. Beaumont Hospital, Wayne State University Medical Center, Royal Oak, Michigan
Michael J. Lyons
Affiliation:
Divisions of Infectious Diseases and Geriatric Medicine, Department of Internal Medicine, Veterans' Affairs Medical Center, University of Michigan Medical School, Ann Arbor, Michigan
Suzanne F. Bradley
Affiliation:
Divisions of Infectious Diseases and Geriatric Medicine, Department of Internal Medicine, Veterans' Affairs Medical Center, University of Michigan Medical School, Ann Arbor, Michigan
Sara A. Hedderwick
Affiliation:
Divisions of Infectious Diseases and Geriatric Medicine, Department of Internal Medicine, Veterans' Affairs Medical Center, University of Michigan Medical School, Ann Arbor, Michigan
Mary A. Ramsey
Affiliation:
Divisions of Infectious Diseases and Geriatric Medicine, Department of Internal Medicine, Veterans' Affairs Medical Center, University of Michigan Medical School, Ann Arbor, Michigan
Laura K. Paul
Affiliation:
Divisions of Infectious Diseases and Geriatric Medicine, Department of Internal Medicine, Veterans' Affairs Medical Center, University of Michigan Medical School, Ann Arbor, Michigan
Carol A. Kauffman*
Affiliation:
Divisions of Infectious Diseases and Geriatric Medicine, Department of Internal Medicine, Veterans' Affairs Medical Center, University of Michigan Medical School, Ann Arbor, Michigan
*
Veterans' Affairs Medical Center, 2215 Fuller Rd, Ann Arbor, MI 48105
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Abstract

Objective:

To compare the epidemiology of vancomycin-resistant Enterococcus faecium (VRE) in a longterm–care unit and an acute-care hospital.

Design:

Point-prevalence surveys for VRE rectal colonization of patients were carried out over a 21-month period in patients in a long-term–care unit and an acutecare hospital (medical ward and intensive-care units). The environment and hands of healthcare workers also were sampled for VRE. Contour-clamped homogeneous electric field (CHEF) electrophoresis was used to evaluate possible transmission among roommates and the relatedness of patient strains to those in the environment and on the hands of healthcare workers.

Setting:

A 200-bed Veterans Affairs Medical Center with an attached 90-bed long-term–care unit.

Results:

From December 1994 to January 1996, rectal VRE colonization of patients in the long-term–care unit increased significantly from 9% to 22%. In contrast, patients on the medical ward rarely were colonized after the first survey in December 1994, and only two intensivecare–unit patients were found to be colonized during the four surveys. The environment was contaminated persistently in the long-term–care unit. In the four surveys, carriage of VRE on hands of healthcare workers varied from 13% to 41%; 65% of healthcare workers with VRE found on their hands worked in the long-term–care unit.

Seven different strains were identified by CHEF typing. Although the initial survey found only vanA strains, subsequent surveys showed vanB strains also were present.

Conclusions:

Residents of a long-term–care unit frequently were colonized with VRE, but infections were uncommon in this population. The environment of the long-term–care unit was contaminated with VRE, and VRE was found frequently on the hands of healthcare workers in this unit. Both vanA and vanB genotypes were found in this setting.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 5 , May 1997 , pp. 333 - 339
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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References

1. Murray, BE. The life and times of the Enterococcus . Clin Microbiol Rev 1990;3:46–65.CrossRefGoogle ScholarPubMed
2. Moellering, RC. Emergence of Enterococcus as a significant pathogen. Clin Infect Dis 1992;14:1173–1178.CrossRefGoogle ScholarPubMed
3. Zervos, MJ, Kauffman, CA, Therasse, PM, Bergman, AG, Mikesell, TS, Schaberg, DS. Nosocomial infection by gentamicinresistant Streptococcus faecalis: an epidemiologic study. Ann Intern Med 1987;106:687–691.CrossRefGoogle Scholar
4. Emori, TG, Gaynes, RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428–442.CrossRefGoogle ScholarPubMed
5. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
6. Karanfil, LV, Murphy, M, Josephson, A, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195–200.CrossRefGoogle Scholar
7. Handwerger, S, Raucher, B, Altarac, D, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.CrossRefGoogle ScholarPubMed
8. Montecalvo, MA, Horowitz, H, Gedris, C, et al. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.CrossRefGoogle Scholar
9. Edmond, MB, Ober, JF, Weinbaum, DL, et al. Vancomycinresistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1126–1133.CrossRefGoogle Scholar
10. Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrugresistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.CrossRefGoogle Scholar
11. Boyle, JF, Soumakis, SA, Rendo, A, et al. Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci. J Clin Microbiol 1993;31:1280–1285.CrossRefGoogle ScholarPubMed
12. Chow, JW, Kuritza, A, Shlaes, DM, Green, M, Sahm, DF, Zervos, MJ. Clonal spread of vancomycin-resistant Enterococcus faecium between patients in three hospitals in two states. Antimicrob Agents Chemother 1993;31:1609–1611.Google ScholarPubMed
13. Moreno, F, Grota, P, Crisp, C, et al. Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium during its emergence in a city in southern Texas. Clin Infect Dis 1995;21:1234–1237.CrossRefGoogle Scholar
14. Livornese, LL, Dias, S, Samel, C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.CrossRefGoogle ScholarPubMed
15. Yamaguichi, E, Valena, F, Smith, SM, Simmons, A, Eng, RH. Colonization pattern of vancomycin-resistant Enterococcus faecium . Am J Infect Control 1994;22:202–206.CrossRefGoogle Scholar
16. 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.CrossRefGoogle ScholarPubMed
17. Jordens, JZ, Bates, J, Griffiths, DT. Faecal carriage and nosocomial spread of vancomycin-resistant Enterococcus faecium . J Antimicrob Chemother 1994;34:515–528.CrossRefGoogle ScholarPubMed
18. 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.CrossRefGoogle ScholarPubMed
19. Larson, EL, Strom, MS, Evans, CA. Analysis of three variables in sampling solutions used to assay bacteria of hands: type of solution, use of antiseptic neutralizers, and solution temperature. J Clin Microbiol 1980;12:335–360.CrossRefGoogle ScholarPubMed
20. Facklam, RR, Collins, MD. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol 1989;27:731–734.CrossRefGoogle ScholarPubMed
21. National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility testing for bacteria that grow aerobically. Villanova, PA: NCCLS; 1993. Document M7-A3.Google Scholar
22. Donabedian, SM, Chow, JW, Boyce, JM, et al. Molecular typing of ampicillin-resistant, non-β-lactamase-producing Enterococcus faecium isolates from diverse geographic areas. J Clin Microbiol 1992;30:2757–2761.CrossRefGoogle ScholarPubMed
23. Donabedian, S, Chow, JW, Shlaes, DM, et al. DNA hybridization and contour-clamped homogeneous electric field electrophoresis for identification of enterococci to the species level. J Clin Microbiol 1995;33:141–145.CrossRefGoogle Scholar
24. Green, M, Barbadora, K, Donabedian, S, et al. Comparison of field inversion gel electrophoresis with contour-clamped homogenous electric field electrophoresis as a typing method for Enterococcus faecium . J Clin Microbiol 1995;33:1554–1557.CrossRefGoogle Scholar
25. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
26. Leclercq, R, Derlot, E, Duval, J, Courvalin, P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium . N Engl J Med 1988;319:157–161.CrossRefGoogle ScholarPubMed
27. Morris, JT Jr, Shay, DK, Hebden, JN, et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin. Establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250–259.CrossRefGoogle Scholar
28. 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.CrossRefGoogle ScholarPubMed
29. Wells, CL, Juni, BA, Cameron, SB, et al. Stool carriage, clinical isolation, and mortality during an outbreak of vancomycinresistant enterococci in hospitalized medical and/or surgical patients. Clin Infect Dis 1995;21:45–50.CrossRefGoogle ScholarPubMed
30. Noskin, GA, Cooper, I, Peterson, LR. Vancomycin-resistant Enterococcus faecium sepsis following persistent colonization. Arch Intern Med 1995;155:1445–1447.CrossRefGoogle ScholarPubMed
31. Montecalvo, MA, de Lencastre, H, Carraher, M, et al. Natural history of colonization with vancomycin-resistant Enterococcus faecium . Infect Control Hosp Epidemiol 1995;16:680–685.CrossRefGoogle ScholarPubMed
32. Sargent, SJ, Baselski, VS, Reed, LD, Wong, L, Sahm, DF. Simultaneous hospital and community emergence of vancomycin-resistant Enterococcus faecium . Clin Infect Dis 1995;21:729. Abstract.Google Scholar
33. Revuelta, MP, Nord, JA, Yarrish, RL, Kislak, JW, LaBombardi, V. Recycling of hospital-acquired colonization with vancomycin resistant enterococci via nursing home residents. Clin Infect Dis 1995;21:730. Abstract.Google Scholar
34. Quale, J, Patel, K, Zaman, M, et al. Fecal carriage of vancomycinresistant enterococci in nursing home and hospitalized patients. Clin Infect Dis 1995;21:733. Abstract.Google Scholar
35. Boyce, JM, Mermel, LA, Zervos, MJ, et al. Controlling vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1995;16:634–637.CrossRefGoogle ScholarPubMed
36. Slaughter, S, Hayden, MK, Nathan, C, et al. 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 1996;125:448–456.CrossRefGoogle Scholar
37. Bonilla, HF, Zervos, MA, Kauffman, CA. Long-term survival of vancomycin-resistant Enterococcus faecium on a contaminated surface. Infect Control Hosp Epidemiol 1996;17:770–772. Letter.CrossRefGoogle ScholarPubMed
38. Wright, W, Korb, S, Karabaic, M, et al. Prospective study of the epidemiology of vancomycin-resistant Enterococcus colonization among ICU patients. Infect Control Hosp Epidemiol 1995;16:P18. Abstract.Google Scholar
39. 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.CrossRefGoogle ScholarPubMed
40. Locksley, RM, Cohen, ML, Quinn, TC, et al. Multiply antibioticresistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection. Ann Intern Med 1982;97:317–324.CrossRefGoogle Scholar
41. Ward, TT, Winn, RE, Hartstein, AI, Sewell, DL. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control. Infect Control 1981;2:453–459.CrossRefGoogle Scholar
42. Bradley, SF, Terpenning, MS, Ramsey, MA, et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.CrossRefGoogle Scholar
43. Spindel, SJ, Strausbaugh, LJ, Jacobson, C. Infections caused by Staphylococcus aureus in a Veterans' Affairs nursing home care unit: a 5-year experience. Infect Control Hosp Epidemiol 1995;16:217–223.CrossRefGoogle Scholar
44. Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a longterm care facility. Ann Intern Med 1991;114:107–112.CrossRefGoogle Scholar
45. Barg, NL. Environmental contamination with Staphylococcus aureus and outbreaks: the cause or the effect? Infect Control Hosp Epidemiol 1993;14:367–368.CrossRefGoogle ScholarPubMed
46. Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, II: epidemiologic studies. J Infect Dis 1979;139:280–287.CrossRefGoogle ScholarPubMed
47. Opal, SM, Mayer, KH, Stenberg, MJ, et al. Frequent acquisition of multiple strains of methicillin-resistant Staphylococcus aureus by healthcare workers in an endemic hospital environment. Infect Control Hosp Epidemiol 1990;11:479–485.CrossRefGoogle Scholar