Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Prevalence and Risk Factors of Vancomycin-Resistant Enterococci (VRE) Colonization in Neonates

신생아에서 Vancomycin 내성 장구균의 감시 및 위험인자 분석

  • Lee, Hwa Yun (Department of Pediatrics, St. Carollo Hospital) ;
  • Kim, Gi Hwan (Department of Pediatrics, St. Carollo Hospital) ;
  • Choi, Jin Su (Department of Pediatrics, St. Carollo Hospital) ;
  • Kim, Sun Hee (Department of Pediatrics, Chonnam University Medical School) ;
  • Choi, Young Youn (Department of Pediatrics, Chonnam University Medical School) ;
  • Hwang, Tai Ju (Department of Pediatrics, Chonnam University Medical School)
  • 이화윤 (순천 성가롤로병원 소아과) ;
  • 김기환 (순천 성가롤로병원 소아과) ;
  • 최진수 (순천 성가롤로병원 소아과) ;
  • 김선희 (전남대학교 의과대학 소아과학교실) ;
  • 최영륜 (전남대학교 의과대학 소아과학교실) ;
  • 황태주 (전남대학교 의과대학 소아과학교실)
  • Received : 2005.04.18
  • Accepted : 2005.06.22
  • Published : 2005.09.15
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Abstract

Purpose : Vancomycin-resistant enterococci(VRE) are now nosocomial pathogens in Korea. But little is known about the prevalence of stool colonization with VRE in neonates in Korea. So we studied the prevalence and risk factors of VRE colonization in the Neonatal Intensive Care Unit(NICU). Methods : From January 2000 to December 2004, the medical records of 294 neonates(127 cases of VRE group and 167 cases of non-VRE group, according to the results of stool culture) were reviewed retrospectively. We studied the annual prevalence of VRE and risk factors of VRE colonization in neonates. Results : From 2000 to 2003, the prevalence rate of VRE in NICU increased. After preventing VRE transmission, the prevalence rate of VRE has decreased. Conclusion : VRE colonization increased recently. Risk factors of VRE colonization were prematurity, lower birth weight, longer hospitalization and use of vancomycin or 3rd generation cephalosporin, compared with the non-VRE group. To prevent VRE transmission among newborns, aggressive infection control strategies by NICU staffs must be implemented immediately for all babies.

목 적 : 병원 입원환자의 임상 검체에서 vancomycin-resistant enterococci(VRE)의 출현은 1980년대 후반부터 증가하기 시작했으나 국내에서 신생아에 대한 보고는 드물다. 최근 본 병원 신생아 중환자실에서 신생아 대변내 VRE 검출이 증가되어 연도별 발생추이와 위험인자를 알아보고자 하였다. 방 법 : 2000년 1월부터 2004년 12월까지 전남대학교병원 신생아 중환자실과 소아과 병동에 입원한 교정연령 4주 미만의 신생아들 중 대변 배양 검사가 시행된 환아 294명에 대해 병력 기록지를 후향적 조사하였다. VRE의 연도별 분리빈도를 조사하였고 대변 배양검사상 VRE 양성인 군을 연구군, VRE 음성인 군을 대조군으로 하여 VRE 집락형성의 위험인자 및 예후 등을 조사하였다. 결 과 : 전체 신생아 환아 중 대변 내 VRE 검출률은 2000년 0명, 2001년 1명(3.7%), 2002년 74명(60.7%), 2003년 52명(38.2%)으로 최근 들어 증가하는 추세이며 2004년에는 2명(0.8%)으로 줄어들었다. 평균 재태연령은 VRE군 $237.9{\pm}28.7$일, Non-VRE군 $265.7{\pm}18.7$일로 VRE군에서 의의있게 짧았다(P<0.001). 출생체중은 VRE군이 $2,124.9{\pm}893.8g$으로, Non-VRE군 $3,023.8{\pm}718.0g$에 비해 유의하게 작았고(P<0.01), 입원기간도 VRE군이 $30.5{\pm}26.5$일로 Non-VRE군의 $12.3{\pm}11.0$일에 비해 길었다(P<0.001). Vancomycin 사용 빈도는 VRE군이 7.0%로 Non-VRE군 1.2%에 비해 높았고(P<0.05), cepalosporin 사용 빈도는 VRE군이 68.5%로 Non-VRE군 48.5%에 비해 더 높았다(P<0.001). VRE 감염으로 인한 직접적인 사망례는 없었다. 결 론 : 신생아 대변내 VRE 감시 배양 결과 연도별로 VRE 검출이 증가하는 추세였는데, 재태연령이 짧을수록, 출생체중이 작을수록, 3세대 cephalosporin 사용 또는 vancomycin 사용이 잦을수록 의의있게 증가하였다. VRE의 발생을 막기 위해서는 극소 저출생 체중아에 대한 무균적 간호와 불필요한 항생제 남용을 줄여야 할 것으로 사료된다.

Keywords

References

  1. Murray BE. The life and times of the Enterococcus. Clin Microbiol Rev 1990;3;46-65
  2. Cross JT, Jacobs RF. Vancomycin-resistant enterococcal infections. Semin Pediatr Infect Dis 1996;7:162-169 https://doi.org/10.1016/S1045-1870(96)80004-5
  3. Stoll BJ, Gordon T, Korones SB, Shankarans S, Tyson JE, Bauer CR. Late onset sepsis in very low birth weight neonates : a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:63-71 https://doi.org/10.1016/S0022-3476(96)70191-9
  4. Grayson ML, Eliopoulos GM, Wennersten CB, Ruoff KL, De Girolami PC, Ferraco MJ, et al. Increasing resistance to beta-lactam antibiotics among clinical isolates of Enterococcus faecium : a 22-year review at one institution. Antimicrob Agents Chemother 1991;35:2180-4 https://doi.org/10.1128/AAC.35.11.2180
  5. Uttley AH, Collins CH, Naidoo J, George RC. Vancomycinresistant enterococci. Lancet 1988;1:57-8 https://doi.org/10.1016/S0140-6736(01)18851-3
  6. Centers for Disease Control and Prevention. 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 https://doi.org/10.1016/0196-6553(95)90104-3
  7. Bae SJ, Choi GJ, Kim CS, Lee SL, Kim HS, Kang CM. A case of vancomycin-resistant enterococcal sepsis in neonate. Korean J Pediatr Infect Dis 1999;6:261-6
  8. Cheong HJ, Kim WJ, Choi SJ, Lee KW, Choe KW, Park SC. Nationwide questionnaire survey for the prevalence, detection methods, and infection control program of VRE among hospitals. Korean J Infect Dis 2001;33:78-87
  9. Lee DW, Lee KJ, Jang GC, Kim DS, Lee KW, Park ES. Clinical observations in vancomycin-resistant enterococci isolated from pediatric patients. Korean J Pediatr Infect Dis 2001;8:199-205
  10. Rice LB. Emergence of vancomycin-resistant enterococci. Emerg Infect Dis 2001;7:183-7 https://doi.org/10.3201/eid0702.010205
  11. Dobson SR, Baker CJ. Enterococcal sepsis in neonates : features by age at onset and occurrence of focal infection. Pediatrics 1990;85:165-71
  12. Murray BE. Vancomycin-resistant enterococcal infections. N Engl J Med 2000;342:710-21 https://doi.org/10.1056/NEJM200003093421007
  13. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin-United States, 1989-1993. MMWR Morb Mortal Wkly Rep 1993;42:597-9
  14. Moellering RC Jr. Emergence of Enterococcus as a significant pathogene. Clin Infect Dis 1992;14:1173-6 https://doi.org/10.1093/clinids/14.6.1173
  15. Guiot HF, Peetermans WE, Sebens FW. Isolation of vancomycin- resistant enterococci in haematologic patients. Eur J Clin Microbiol Infect Dis 1991;10:32-4 https://doi.org/10.1007/BF01967094
  16. Bingen EH, Denamur E, Lambert-Sechovsky NY, Elion J. Evidence for the genetic unrelation of nosocomial vancomycin- resistant Enterococcus faecium strains in a pediatric hospital. J Clin Microbiol 1991;29:1888-92
  17. Trabulsi A, Glover AM, Reising SF, Christie CD. Absence of rectal colonization with vancomycin-resistant enterococci among high-risk pediatric patients. Infect Control Hosp Epidemiol 1998;19:109-12 https://doi.org/10.1086/647777
  18. Park JW, Kim YR, Shin WS, Kang MW, Han KJ, Shim SI. Susceptibility tests of vancomycin-resistant enterococci. Korean J Infect Dis. 1992;24:133-7
  19. Kim SH, Kim SC, Gu SB, Shin JH, Suh SP, Yang DW. Four case of vancomycin-resistant enterococcal infection. Korean J Clin Pathol 1995;15 suppl:265-8
  20. Cheong HJ, Kim WJ, Woo HJ, Kim MJ, Park SC. Study on the infection due to Van A type vancomycin-resistant enterococci. Korean J Infect Dis 1998;30:10-8
  21. Park JH, Park MS, Park KI, Sohn YM. Clinical observations of a vancomycin-resistant enterococcal outbreak in the neonatal intensive care unit. Proceeding of the 13th Annual Fall Meeting of the Korean Society of Pediatric Infectious Disease; 1999 Nov 28; Seoul. Seoul : The Korean Society of Pediatric Infectious Disease, 1999:277
  22. Cetinkaya Y, Falk P, Mayhall CG. Vancomycin-resistant enterococci. Clin Microbiol Rev 2000;13:686-707 https://doi.org/10.1128/CMR.13.4.686-707.2000
  23. Edmond MB. Multidrug-resistant enterococci and the threat of vancomycin-resistant Staphylococcus aureus. In : Wenzel RP. editors. Prevention and control of nosocomial infections. 3rd ed. Baltimore : Williams and Wilkins, 1997;339-55
  24. Marshall CG, Broad G, Leskiw BK, Wright GD. D-Ala-DAla ligases from glycopeptide antibiotic-producing organisms are highly homologous to the enterococcal vancomycin- resistnace ligases VanA and VanB. Proc Natl Acad Sci USA 1997;94:6480-3
  25. Marshall CG, Lessard IA, Park I, Wright GD. Glycopeptide antibiotic resistance genes in glycopeptide-producing organisms. Antimicrob Agents Chemother 1998;42:2215-20
  26. Green M, Shlaes JH, Bardadora K, Shlaes DM. Bacteremia due to vancomycin-dependent Enterococcus faecium. Clin Infect Dis 1995;20:712-4 https://doi.org/10.1093/clinids/20.3.712
  27. Rice LB, Eckstein EC, Devente J, Shlaes DM. Ceftazidimeresistant Klebsiella pneumonia isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Clin Infect Dis 1996;23:118-24 https://doi.org/10.1093/clinids/23.1.118
  28. Dutka-Malen S, Blaimont B, Wauters G, Courvalin P. Emergence of high-level resistance to glycopeptide in Enterococcus gallinarum and Enterococcus casseliflacus. Antimicrob Agents Chemother 1994;38:1675-7 https://doi.org/10.1128/AAC.38.7.1675
  29. Fines M, Perichon B, Reynolds P, Sahm DF, Courvalin P. Van E. A new type of acquired glycopeptide resistance in Enterococcus faecalis BM4405. Antimicrob Agents Chemother 1999;43:2161-4
  30. Delisle S, Perl TM. Vancomycin-resistant enterococci : a road map on how to prevent the emergence and transmission of antimicrobial resistance. Chest 2003;123:504S-18S https://doi.org/10.1378/chest.123.2.504
  31. Rawlings JS, Smith FR. Garcia J. Expected duration of hospital stay of low birth weight infants : graphic depiction in relation to birth weight and gestational age. J Pediatr 1993;123:307-9 https://doi.org/10.1016/S0022-3476(05)81708-1
  32. Malik RK, Montecalvo MA, Reale MR, Li K, Maw M, Munoz JL, et al. Epidemiology and control of vancomycinresistant enterococci in a regional neonatal intensive care unit. Pediatr Infect Dis J 1999;18:352-6 https://doi.org/10.1097/00006454-199904000-00009
  33. Martinez 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;163:1905-12. https://doi.org/10.1001/archinte.163.16.1905
  34. Harrison CJ. Quinupristin/dalfopristin. Semin Pediatr Infect Dis 2001;12:200-10 https://doi.org/10.1053/spid.2001.24095
  35. Dowzicky M, Talbot GH, Feger C, Prokocimer P, Etienne J, Leclercq R. Characterization of isolates associated with emerging resistnace to quinupristin/dalfopristin(Synercid) during a worldwide clinical program. Diagn Microbiol Infect Dis 2000;37:57-62 https://doi.org/10.1016/S0732-8893(99)00154-6
  36. Rose CM, Reilly KJ, Haith LR, Patton ML, Guilday RJ, Cawley MJ, et al. Emergence of resistance of vancomycinresistant Enterococcus faecium in a thermal injury patient treated with quinupristin-dalfopristin and cultured epitherial autografts for wound closure. Burns 2002;28:696-8 https://doi.org/10.1016/S0305-4179(02)00105-5
  37. Diekema DJ, Jones RN. Oxazolidinone antibiotics. Lancet 2001;358:1975-82 https://doi.org/10.1016/S0140-6736(01)06964-1
  38. Ang JY, Lua JL, Turner DR, Asmar BI. Vancomycin-resistant Enterococcus faecium endocarditis in a premature infant successfully treated with linezolid. Pediatr Infect Dis J 2003;22:1101-3 https://doi.org/10.1097/01.inf.0000101784.83146.0c
  39. Herrero IA, Issa NC, Patel R. Nosocomial spread of linezolid- resistant, vancomycin-resistant Enterococcus faecium. N Engl J Med 2002;346:867-9 https://doi.org/10.1056/NEJM200203143461121
  40. Tsiodras S, Gold HS, Sakoulas G, Eliopoulos GM, Wennersten C, Venkataraman L, et al. Linezolid resistance in a clinical isolate of Staphlyococcus aureus. Lancet 2001;358: 207-8 https://doi.org/10.1016/S0140-6736(01)05410-1