Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지

Colonization Rate and Control of Vancomycin-Resistant Enterococci in the Neonatal Intensive Care Unit

일개 신생아중환자실 반코마이신 저항 장구균(VRE)의 유행 양상과 조절

  • Seo, Jung Ho (Department of Pediatrics, College of Medicine, Pusan National University) ;
  • Nam, Ga Yeon (Department of Pediatrics, College of Medicine, Pusan National University) ;
  • Park, Kyung Hee (Department of Pediatrics, College of Medicine, Pusan National University) ;
  • Byun, Shin Yun (Department of Pediatrics, College of Medicine, Pusan National University) ;
  • Park, Su Eun (Department of Pediatrics, College of Medicine, Pusan National University)
  • 서정호 (부산대학교 의과대학 소아과학교실) ;
  • 남가연 (부산대학교 의과대학 소아과학교실) ;
  • 박경희 (부산대학교 의과대학 소아과학교실) ;
  • 변신연 (부산대학교 의과대학 소아과학교실) ;
  • 박수은 (부산대학교 의과대학 소아과학교실)
  • Received : 2009.10.15
  • Accepted : 2009.11.11
  • Published : 2010.06.25
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Recently, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in Korea. However, there have been few studies on the epidemiology of VRE colonization among neonates. In this study, we investigated the prevalence of VRE colonization, risk factors for VRE, and how to control the spread of VRE infection in the Neonatal Intensive Care Unit (NICU) of Pusan National University Hospital (PNUH). Methods : We retrospectively reviewed medical records of 192 neonates who were admitted to the NICU of PNUH from March 2006 to March 2007. Surveillance cultures from rectal swabs for detecting VRE were obtained weekly during the study period. We analyzed the prevalence of VRE and various risk factors. Results : The rate of VRE colonization among NICU patients was 25% (48/192). Thirty five of these VRE colonized patients were transferred to the NICU from other local hospitals. Compared with the non-VRE group, the risk factors associated with VRE colonization were lower birth weight, congenital heart disease, applied mechanical ventilation, use of a central venous catheter, chest tubing, a history of surgery, and use of antibiotics. Conclusion : VRE colonization among patients admitted to the NICU is rapidly increasing. Monitoring and managing premature neonates from the beginning of the birth process, avoiding many invasive procedures, avoiding antibiotics such as vancomycin and third generation cephalosporin are important for preventing the emergence and spread of VRE colonization in the NICU.

목 적:부산대학교병원 신생아 중환자실에서 2006년 3월 VRE 유행이 나타나 입원 환아를 대상으로 대변VRE 감시 배양을 시행하였다. 본 연구는 VRE 감염의 정착정도를 파악하고, 위험인자를 분석하여 향후 VRE의 출현을 예방하고자 본 연구를 시행하였다. 방 법: 2006년 3월부터 2007년 3월까지 본원 신생아 중환자실 환아 192명을 대상으로 주 1회 대변 감시배양 검사를 시행하였다. VRE가 분리된 환아의 위험인자를 규명하고자 성별, 재태 기간, 기저 질환, 이전 치료에 사용된 항생제의 종류, 침습적 처치의 유무 등을 의무기록을 바탕으로 후향적으로 조사하였다. 결 과:총 192명의 환아 중 VRE 양성군은 48명(25%), VRE 음성군은 189명(75%)이었다. VRE 양성 환아 중 본원 출생아는 12명(25.0%), 타병원 출생아는 36명(75.0%)이었다. VRE 양성 환아의 기저 질환으로는 선천성 심질환이 25명(52.1%)으로 VRE 양성 빈도가 유의하게 높았다(P =0.005). 항생제 중 VRE 양성군에 서 3세대 cephalosporin 사용(45.8% vs. 15.3%, P < 0.001)과 vancomycin 사용(95.8% vs. 40.9%, P < 0.05)의 기왕력이 통계적으로 유의하게 높음을 알 수 있었다. 또한 VRE 양성군에서 중심 정맥 도관(41.7% vs. 15.3%, P <0.001)이나 인공 호흡기(41.7% vs 25.0%, P =0.017)를 사용한 예가 많았고, 수술 여부(41.7% vs 16.7%, P =0.001)나 흉관 삽입의 기왕력(10.4% vs 2.7%, P =0.021)이 통계적으로 유의하게 높았다. VRE양성군 48명 중 11명(22.9%)에서 VRE 음전을 확인 하였고 VRE의 음전기간의 중앙값은 101일 이었다. 결 론: VRE 감염은 신생아 중환자실에서 중요한 원내 감염으로 부각되고 있다. 이러한 VRE 집락을 차단하기 위해서는 철저한 감염 관리와 격리를 해야 하며 침습적인 기구의 사용 및 불필요한 항생제의 사용을 줄이려는 노력이 필요하다.

Keywords

References

  1. Murray BE. The life and times of the Enterococcus. Clin Microbial Rev 1990;3:46-65. https://doi.org/10.1128/CMR.3.1.46
  2. Lee HY, Kim GH, Choi JS, Kim SH, Choi YY, Hwang TJ. Prevalence and risk factors of vancomycin-resistant (VRE) colonization in neonates. Korean J Pediatr 2005; 48:946-52.
  3. Weinsten JW, Roe M, Towns M, Sanders A, Thorpe JJ, Corey R. Resistant enterococci : A prospective study of prevalence, incidence, and factors associated with colonization in a university hospital. Infect Control and Epidemiol 1996;17:36-41. https://doi.org/10.1086/647186
  4. Bae SJ, Choi GH, 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.
  5. Kim DR, Yu CW, Cheong HJ, Woo HJ, Kim WJ, Kim MJ et al. Rectal surveillance culture of vancomycinresistant enterococci (VRE) colonization among patients hospitalized in the intensive care unit (ICU). Korean J Infect Dis 1999;31:203-9.
  6. Moellering RC Jr. : Enterococcus sepsis, Streptococcus bovis and Leuconostoc. In : Mandell GL, Bennet JE, Dolin R, eds. Mandell, Douglas, and Bennet's principles and practice of infectious disease 1995;4:1826-35.
  7. Leclercq R, Derlot E, Duval J, Courvalin P. Plasmidmediated resistance to vancomycin and teicoplanin. N Engl J Med 1998;319:157-61.
  8. Cheong HJ, Kim WJ, Choi SJ, Lee KW, Choe KW, Park SC. Nationwide questionnaire survey for the prevalence, detection method, and infection control program of VRE among hospitals. Korean J Infect Dis 2001;33:78-87. https://doi.org/10.1086/321861
  9. Park JW, Kim YR, Shin WS, Kang MW, Han KJ, Shim SI. Susceptibility test of vancomycin-resistant enterococci. Korean J Infect Dis 1992;24:133-7.
  10. Kim WJ, Weinsten RA, Hayden MK. The changing molecular epidemiology and establishment of epidemicity of vancomycin-resistant enterococci at one hospital over a 6-year period. J Infec Dis 1999;179:163-71. https://doi.org/10.1086/314564
  11. Cheong HJ, Song JY, Eom JS, Kim WJ, Choi SJ, Choi JH, et al. Colonization rate, risk factor for acquisition and genetic diversity of vancomycin-resistant enterococci isolated from rectal culture of patients in Intensive Care Units from ten large hospitals in Korea. Korean J Infect Dis 2002;34:276-84.
  12. Hospital Infection Control Practice Advisory Committes (HICPAC) : Recommendations for preventing the spread of vancomycin resistance. Infect Contral Hosp Epidemiol 1995;10:105-13.
  13. 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.
  14. Dobson SR, Baker CJ. Enterococcal sepsis in neonates : features by age at onset and occurrence of focal infection. Pediatrics 1990;85:165-71.
  15. Uttley AH, Collins CH, Naidoo J, George RC. Vancomycin- resistant enterococci. Lancet 1988;1:57-8.
  16. Gold HS, Moellering RC Jr. Drug therapy : antimicrobial- drug resistance. N Engl J Med 1993;167:1220-3.
  17. Fuller RE, Drew RH, Perfect JR. Treatment of vancomycin- resistant enterococci with a focus on Quinupristin- Dalfopristin. Pharmacotherapy 1996;16:584-92.
  18. Noskin GA. Vancomycin-resistant enterococci : Clinical, microbiologic, and epidemiologic features. J Lab Clin Med 1997;130:14-20. https://doi.org/10.1016/S0022-2143(97)90054-8
  19. Chung SH, Lee DH, Chung TJ, Chung JH, Kim MH, Koo JY, et al. Colonization features of intestinal vancomycin- resistant enterococci. KONIS 1998;3:41-7.
  20. Park JH, Park MS, Park MI, 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.
  21. Gordts B, Van-Landuty H, Ieven M, Vandamme P, Goossens H. Vancomycin-resistant enterococci colonizing the intestinal tracts of hospitalized patients. J Clin Microbiol 1995;33:2842-46.
  22. Malik RK, Montecalvo MA, Reale MR, Li K, Maw M, Munoz JL et al. Epidemiology and control of vancomycin- resistant enterococci in a regional neonatal intensive care unit. Pediatr Infect Dis J 1999;18:352-6. https://doi.org/10.1097/00006454-199904000-00009
  23. de Vera ME, Simmons RL. Antibiotic-resistant enterococci and the changing face of surgical infections. Arch Surg 1996;131:338-42. https://doi.org/10.1001/archsurg.1996.01430150116021
  24. Rao GG, Ojo F, Kolokithas S. de Vera ME, Simmons RL. Vancomycin-resistant gram-positive cocci : risk factors for faecal carriage. J Hosp Infect 1997;35:63-9. https://doi.org/10.1016/S0195-6701(97)90169-9
  25. Andrew DL. Relative importance of oral versus intravenous vancomycin exposure in the development of vancomycin- resistant enterococci. J Infect Dis 1996;173: 1292-3. https://doi.org/10.1093/infdis/173.5.1292
  26. 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
  27. Manso EG, Sio De, Biavasco F, Varaldo PE, Sambo G, Maffei C, et al. Vancomycin-resistant enterococci. Lancet 1993;342:616-7.
  28. 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. J Clin Microbiol 1993;31:1609-11.
  29. Montecalvo MA, Lencastre H, Carraher M, Gedris C, Chung M, VanHorn K. National history of colonization with vancomycin-resistant enterococcus faecium. Infect Control Hosp Epidemiol 1995;16:680-5. https://doi.org/10.1086/647041