First report of clinical and epidemiologic characterisation of vancomycin-resistant enterococci from mainland China
Abstract number: O515
Cao B., Liu Y., Wang H., Song S., Li R., Wang C.
Objectives: Although infections caused by vancomycin-resistant enterococci (VRE) have been reported increasingly worldwide, there have been rarely reported in mainland China. We investigated the clinical and epidemiological characteristics of VRE nosocomial infections in Beijng Chaoyang Hospital, a 1100-bed tertiary-care teaching hospital in Beijing, China.
Methods: A matched case-control study was conducted to identify the individual risk factors for VRE infection/colonisation, and a retrospective cohort study to examine the prognostic factors of VRE infection. van genes were detected by multiplex PCR. Pulsed-field gel electrophoresis was used for molecular typing.
Results: The rates of VRE isolation increased from 2.6% for 2003 to 6.8% for 2006. A total of 38 vancomycin-resistant single-patient isolates of VRE were recovered between June 2003 and March 2007. The multivariate analysis revealed two significant independent risk factors for VRE versus vancomycin-susceptible enterococci (VSE): previous use of vancomycin (OR 18.22; 95% CI, 4.5772.6) and inclusion in a dialysis programme (OR 8.69; 95% CI, 1.9438.84). Having a malignant disease remained protective in the multivariate model (OR 0.26, 95%CI, 0.070.97). Crude mortality rate differences were not statistically significant (VRE 53.6% vs VSE 38.6%; OR, 1.066; p = 0.915). The only epidemiologic risk factor for associated mortality by multivariate analysis was increasing severity of illness, measured by APACHE II score (VRE 17.49± 6.83 vs VSE 11.81±4.85; p = 0.001). The total hospital stay was longer in VRE-infected patients than in those with VSE infections (VRE 55.2±27.2 ds vs VSE 39.3±30.7 ds; p = 0.022). van B gene was detected in 14 E. faecalis isolates, all of which were identified as a single clone that was prominent before the year 2005. vanA gene was positive in 21 E. faecium isolates, 10 of which showed resistant to vancomycin (MIC 256mg/L), but sensitive to teicoplanin (MICs 212 mg/L). Twenty-one isolates of E. faecium belonged to 9 different clones, 90.4% of which were isolated in year 2006 and 2007.
Conclusion: There has been a significant increase in the numbers of VRE infections over 3 years in our institute. Previous vancomycin therapy and involvement in dialysis programme were risk factors for development of VRE infections. Surveillance for VRE, prudent use of vancomycin and strict adherence to infection control measures are required to prevent further emergence and spread of VRE.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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