Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T04:57:12.419Z Has data issue: false hasContentIssue false
  • English
  • Français

Outbreaks of Vancomycin-Resistant Enterococci in Hospital Settings: A Systematic Review and Calculation of the Basic Reproductive Number

Published online by Cambridge University Press:  16 December 2015

Laetitia Satilmis ,
Philippe Vanhems  and
Thomas Bénet
Laetitia Satilmis
Affiliation:
Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
Philippe Vanhems*
Affiliation:
Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France International Center for Infectiology Research, Lyon 1 University, Lyon, France
Thomas Bénet
Affiliation:
Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France International Center for Infectiology Research, Lyon 1 University, Lyon, France
*
Address correspondence to Philippe Vanhems, MD, PhD, Service d’Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d’Arsonval, 69437 Lyon CEDEX 03, France (philippe.vanhems@chu-lyon.fr).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

Vancomycin-resistant enterococci (VRE) have spread worldwide.

OBJECTIVE

To systematically review VRE outbreaks and estimate the pooled basic reproductive rate (R0) of VRE.

METHODS

Eligible studies criteria were (1) published within 10 years, (2) report outbreak details, (3) involve 1 center, (4) estimate epidemic duration, and (5) concern adults. Descriptive analysis included number of index cases, secondary cases, and screened patients; infection control measures; and definition of contact patients. R0 was estimated by the equation R0=(ln2) D/td+1, with D as the generation time and td as the doubling time.

RESULTS

Thirteen VRE outbreaks were retained from 180 articles and, among them, 10 were kept for R0 calculation. The mean (range) number of index cases was 2.3 (1–8) and the mean (range) number of secondary cases was 15 (3–56). The mean (range) number of screened patients was 174 (32–509), with pooled VRE prevalence of 5.4% (95% CI, 4.5%–6.3%). Contact precautions were reported in 12 studies (92%), wards were closed in 7 (54%), with cohorting in 6 (46%). Two major screening policies were implemented: (1) a surveillance program in the unit or hospital (7 studies [54%]) and (2) screening of selected contact patients (6 studies [46%]). The pooled R0 of VRE was 1.32 (interquartile range, 1.03–1.46).

CONCLUSION

We discerned considerable heterogeneity in screening policies during VRE outbreaks. Pooled R0 was higher than 1, confirming the epidemic nature of VRE.

Infect. Control Hosp. Epidemiol. 2016;37(3):289–394

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 3 , March 2016 , pp. 289 - 294
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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

REFERENCES

1. Uttley, AH, Collins, CH, Naidoo, J, George, RC. Vancomycin-resistant enterococci. Lancet 1988;1:57–58.Google Scholar
2. 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.Google Scholar
3. Werner, G, Coque, TM, Hammerum, AM, et al. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill 2008:13. pii:19046.Google ScholarPubMed
4. Deshpande, LM, Fritsche, TR, Moet, GJ, Biedenbach, DJ, Jones, RN. Antimicrobial resistance and molecular epidemiology of vancomycin-resistant enterococci from North America and Europe: a report from the SENTRY antimicrobial surveillance program. Diagn Microbiol Infect Dis 2007;58:163–170.CrossRefGoogle ScholarPubMed
5. Willems, RJL, Top, J, van Santen, M, et al. Global spread of vancomycin-resistant Enterococcus faecium from distinct nosocomial genetic complex. Emerg Infect Dis 2005;11:821–828.Google Scholar
6. Molton, JS, Tambyah, PA, Ang, BSP, Ling, ML, Fisher, DA. The global spread of healthcare-associated multidrug-resistant bacteria: a perspective from Asia. Clin Infect Dis 2013;56:1310–1318.Google Scholar
7. Hidron, AI, Edwards, JR, Patel, J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996–1011.Google Scholar
8. Orsi, GB, Ciorba, V. Vancomycin resistant enterococci healthcare-associated infections. Ann Ig Med Prev E Comunità 2013;25:485–492.Google ScholarPubMed
9. Friães, A, Resina, C, Manuel, V, Lito, L, Ramirez, M, Melo-Cristino, J. Epidemiological survey of the first case of vancomycin-resistant Staphylococcus aureus infection in Europe. Epidemiol Infect 2015;143:745–748.Google Scholar
10. Limbago, BM, Kallen, AJ, Zhu, W, Eggers, P, McDougal, LK, Albrecht, VS. Report of the 13th vancomycin-resistant Staphylococcus aureus isolate from the United States. J Clin Microbiol 2014;52:998–1002.CrossRefGoogle ScholarPubMed
11. Moravvej, Z, Estaji, F, Askari, E, Solhjou, K, Naderi Nasab, M, Saadat, S. Update on the global number of vancomycin-resistant Staphylococcus aureus (VRSA) strains. Int J Antimicrob Agents 2013;42:370–371.Google Scholar
12. Escaut, L, Bouam, S, Frank-Soltysiak, M, et al. Eradication of an outbreak of vancomycin-resistant Enterococcus (VRE): the cost of a failure in the systematic screening. Antimicrob Resist Infect Control 2013;2:18.CrossRefGoogle ScholarPubMed
13. Austin, DJ, Bonten, MJ, Weinstein, RA, Slaughter, S, Anderson, RM. Vancomycin-resistant enterococci in intensive-care hospital settings: transmission dynamics, persistence, and the impact of infection control programs. Proc Natl Acad Sci U S A 1999;96:6908–6913.CrossRefGoogle ScholarPubMed
14. Lowden, J, Miller Neilan, R, Yahdi, M. Optimal control of vancomycin-resistant enterococci using preventive care and treatment of infections. Math Biosci 2014;249:8–17.Google Scholar
15. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med 2009;6:e1000097.Google Scholar
16. Anderson, RM, Fraser, C, Ghani, AC, et al. Epidemiology, transmission dynamics and control of SARS: the 2002-2003 epidemic. Philos Trans R Soc Lond B Biol Sci 2004;359:1091–1105.Google Scholar
17. Bonten, MJ, Hayden, MK, Nathan, C, et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:1615–1619.Google Scholar
18. Marcadé, G, Micol, JB, Jacquier, H, et al. Outbreak in a haematology unit involving an unusual strain of glycopeptide-resistant Enterococcus faecium carrying both vanA and vanB genes. J Antimicrob Chemother 2014;69:500–505.Google Scholar
19. Liu, Y, Cao, B, Gu, L, Liu, K, Feng, Z. Successful control of vancomycin-resistant Enterococcus faecium nosocomial outbreak in a teaching hospital in China. Am J Infect Control 2012;40:568–571.Google Scholar
20. Tuon, FF, Penteado-Filho, SR, Camilotti, J, van der Heijden, IM, Costa, SF. Outbreak of vancomycin-resistant Enterococcus in a renal transplant unit. Braz J Infect Dis 2011;15:403–405.CrossRefGoogle Scholar
21. Brossier, F, Lefrançois, S, Paute, J, et al. Decolonisation for early control of an outbreak of vancomycin-resistant Enterococcus faecium in a geriatric rehabilitation care facility. J Hosp Infect 2010;76:368–369.Google Scholar
22. Servais, A, Mercadal, L, Brossier, F, et al. Rapid curbing of a vancomycin-resistant Enterococcus faecium outbreak in a nephrology department. Clin J Am Soc Nephrol 2009;4:1559–1564.CrossRefGoogle Scholar
23. Cheng, VC, Chan, JF, Tai, JW, et al. Successful control of vancomycin-resistant Enterococcus faecium outbreak in a neurosurgical unit at non-endemic region. Emerg Health Threats J 2009;2:e9.Google Scholar
24. Chlebicki, MP, Ling, ML, Koh, TH, et al. First outbreak of colonization and infection with vancomycin-resistant Enterococcus faecium in a tertiary care hospital in Singapore. Infect Control Hosp Epidemiol 2006;27:991–993.CrossRefGoogle Scholar
25. 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.Google Scholar
26. Naas, T, Fortineau, N, Snanoudj, R, Spicq, C, Durrbach, A, Nordmann, P. First nosocomial outbreak of vancomycin-resistant Enterococcus faecium expressing a VanD-like phenotype associated with a vanA genotype. J Clin Microbiol 2005;43:3642–3649.CrossRefGoogle ScholarPubMed
27. Al-Mohri, HA, Tadros, MA, Louie, L, Vearncombe, M, Simor, AE. Utility of direct, real-time PCR in the management of a nosocomial outbreak of vancomycin-resistant Enterococcus faecium (vanB genotype). Eur J Clin Microbiol Infect Dis 2008;27:321–322.Google Scholar
28. Deplano, A, Denis, O, Nonhoff, C, et al. Outbreak of hospital-adapted clonal complex-17 vancomycin-resistant Enterococcus faecium strain in a haematology unit: role of rapid typing for early control. J Antimicrob Chemother 2007;60:849–854.CrossRefGoogle Scholar
29. 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
30. Prévention de la transmission croisée des “Bactéries Hautement Résistantes aux antibiotiques émergentes.” Haut Conseil de la Santé Publique website. http://www.hcsp.fr/Explore.cgi/avisrapportsdomaine?clefr=372. Published 2013. Accessed August 25, 2014.Google Scholar
31. ■. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). Am J Infect Control 1995;23:87–94.Google Scholar