title: Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention.
abstract: The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE) outbreak in a tertiary-care pediatric intensive care unit (PICU) of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75% reduction), and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.
authors.affiliation: Centro de Terapia Intensiva Pediátrico, Departamento de Puericultura e Pediatria, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brasil. carmona@fmrp.usp.br
authors.forename: F
authors.initials: F
authors.lastname: Carmona
authors.forename: S I
authors.initials: SI
authors.lastname: Prado
authors.forename: M F I
authors.initials: MF
authors.lastname: Silva
authors.forename: G G
authors.initials: GG
authors.lastname: Gaspar
authors.forename: F
authors.initials: F
authors.lastname: Bellissimo-Rodrigues
authors.forename: R
authors.initials: R
authors.lastname: Martinez
authors.forename: A K
authors.initials: AK
authors.lastname: Matsuno
authors.forename: A P C P
authors.initials: AP
authors.lastname: Carlotti
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D004196:Disease Outbreaks; D016983:Enterococcus / Q000187:drug effects*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D008297:Male; D015397:Program Evaluation; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage*; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin