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Reduced rates of vancomycin-resistant enterococci colonisation after implementation of infection control measures

Abstract number: 1733_1193

Galani L., Sakka V., Tsiodras S., Pantelaki M., Galani I., Souli M., Antoniadou A., Athanasia S., Kontopidou F.V., Nikolaou H., Fytrou H., Siafakas N., Zerva L., Giamarellou H.

Objective: The aim of the study was to evaluate the effect of infection control measures that were applied during one year period after an outbreak of ancomycin resistant enterococci (VRE) colonisation in our hospital.

Methods: A hospital wide prevalence study was performed during the 20 April–30 May 2005 period, recording faecal carriage and clinical VRE isolation. Presence of vancomycin resistance genes and species identification was assessed by multiplex PCR and clonality of isolates by PFGE. A case-control design, using two randomly selected VRE(-) controls for each positive case, was performed to identify cases with VRE colonisation and to evaluate risk factors for such colonisation. Control measures including patient cohorting, education efforts about hand hygiene and control of vancomycin use were instituted. An active surveillance problem was established for high risk patients identified through the case control study. A new survey was conducted in October 2006 in order to evaluate all control efforts.

Results: During the initial outbreak of colonisation 460 samples were evaluated from 367 patients. Total mean VRE carriage was initially 19.7%. All isolates were identified as E. faecium, with vanA genotype. Multivariate analysis identified immunodeficiency (OR 3.7, 95% CI: 1.4–9.3), any invasive device (OR 5.5, 95% CI: 2.2–13.9), and duration of antimicrobial treatment prior to VRE isolation (OR 1.2, 95% CI: 1.1–1.3) as the most important predictors for VRE positivity. During the 2nd screening 132 patients were screened and 11 were found to be positive for VRE colonisation (8.3%, p = 0.01). Of these, 4 (3%) were hospitalised in the orthopaedics department, 4 (3%) in the haematology unit and the other 3 in internal medicine wards. VRE colonisation was detected only in patients at high risk who had been already put in cohort for other multidrug resistance pathogens.

Conclusions: The implementation of infection control measures and an active surveillance screening programme targeting high risk patients resulted in a significant decrease of VRE isolation rates. High rates of VRE colonisation can be controlled by timely and intensively applied infection control and antibiotic use measures, preventing the emergence of clinical infections.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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