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

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)
Publication Information
Pediatric Infection and Vaccine / v.17, no.1, 2010 , pp. 1-8 More about this Journal
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.
Keywords
Vancomycin Resistance; Enterococci; Infant; Newborn; Risk factors;
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1 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.   DOI   ScienceOn
2 Murray BE. The life and times of the Enterococcus. Clin Microbial Rev 1990;3:46-65.   DOI
3 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.
4 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.   DOI   ScienceOn
5 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.
6 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.
7 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.
8 Leclercq R, Derlot E, Duval J, Courvalin P. Plasmidmediated resistance to vancomycin and teicoplanin. N Engl J Med 1998;319:157-61.
9 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.   DOI   ScienceOn
10 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.
11 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.   DOI   ScienceOn
12 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.
13 Hospital Infection Control Practice Advisory Committes (HICPAC) : Recommendations for preventing the spread of vancomycin resistance. Infect Contral Hosp Epidemiol 1995;10:105-13.
14 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.
15 Dobson SR, Baker CJ. Enterococcal sepsis in neonates : features by age at onset and occurrence of focal infection. Pediatrics 1990;85:165-71.
16 Uttley AH, Collins CH, Naidoo J, George RC. Vancomycin- resistant enterococci. Lancet 1988;1:57-8.
17 Gold HS, Moellering RC Jr. Drug therapy : antimicrobial- drug resistance. N Engl J Med 1993;167:1220-3.
18 Fuller RE, Drew RH, Perfect JR. Treatment of vancomycin- resistant enterococci with a focus on Quinupristin- Dalfopristin. Pharmacotherapy 1996;16:584-92.
19 Noskin GA. Vancomycin-resistant enterococci : Clinical, microbiologic, and epidemiologic features. J Lab Clin Med 1997;130:14-20.   DOI   ScienceOn
20 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.
21 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.
22 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.
23 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.   DOI   ScienceOn
24 de Vera ME, Simmons RL. Antibiotic-resistant enterococci and the changing face of surgical infections. Arch Surg 1996;131:338-42.   DOI   ScienceOn
25 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.   DOI   ScienceOn
26 Andrew DL. Relative importance of oral versus intravenous vancomycin exposure in the development of vancomycin- resistant enterococci. J Infect Dis 1996;173: 1292-3.   DOI   ScienceOn
27 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.   DOI   ScienceOn
28 Manso EG, Sio De, Biavasco F, Varaldo PE, Sambo G, Maffei C, et al. Vancomycin-resistant enterococci. Lancet 1993;342:616-7.
29 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.