Control of vancomycin-resistant enterococci in the neonatal intensive care unit.
OBJECTIVE
Multidrug-resistant organisms (MDROs), such as vancomycin-resistant enterococci (VRE), cause serious infections, especially among high-risk patients in NICUs. When VRE was introduced and transmitted in our NICU despite recommended infection control practices, we instituted active surveillance cultures to determine their efficacy in detecting and controlling spread of VRE among high-risk infants.


METHODS
Active surveillance cultures, other infection control measures, and a mandatory in-service education module on preventing MDRO transmission were implemented. Cultures were performed on NICU admission and then weekly during their stay. Molecular DNA fingerprinting of VRE isolates facilitated targeting efforts to eliminate clonal spread of VRE. Repetitive sequence PCR (rep-PCR)-based DNA fingerprinting was used to compare isolates recovered from patients with VRE infection or colonization. Environmental VRE cultures were performed around VRE-colonized or -infected patients. DNA fingerprints were prepared from the products of rep-PCR amplification and analyzed using software to determine strain genetic relatedness.


RESULTS
Active surveillance cultures identified 65 patients with VRE colonization or infection among 1,820 admitted to the NICU. Rep-PCR performed on 60 VRE isolates identified 3 clusters. Cluster 1 included isolates from 21 patients and 4 isolates from the environment of the index patient. Clusters 2 and 3 included isolates from 23 and 3 patients, respectively. Similarity coefficients among the members of each cluster were 95% or greater.


CONCLUSIONS
Control of transmission of multi-clonal VRE strains was achieved. Active surveillance cultures, together with implementation of other infection control measures, combined with rep-PCR DNA fingerprinting were instrumental in controlling VRE transmission in our NICU.
Singh
Nalini
N
Department of Pediatrics, George Washington University School of Medicine, Washington, DC 20010, USA. Nsingh@cnmc.org
Léger
Marie-Michèle
MM
Campbell
Joyce
J
Short
Billie
B
Campos
Joseph M
JM
D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D004219:District of Columbia / Q000453:epidemiology; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D020713:Vancomycin Resistance