title: [Vancomycin-resistant enterococcus colonization in neonatal intensive care unit: prevention and eradication experience].
abstract: Vancomycin resistant enterococci (VRE) are important etiologic agents of nosocomial infections and colonization for hospitalized patients. Isolation rate of VRE is higher especially in neonatal intensive care units (NICUs), due to the immune insufficiency of neonates, frequent use of antibiotics and prolonged duration of hospitalization. The aims of this report were to present the rapid dissemination of VRE colonization in our NICU, to determine the factors related to colonization and to share the precautions taken to prevent the dissemination. Upon the isolation of VRE from the urine culture of a premature infant followed up in the NICU, rectal swab specimens were obtained from this index patient, other patients staying at the NICU, the related health-care personnel and also environmental sampling was performed. Although strict contact precautions were implemented for the VRE positive patient, VRE were isolated from the rectal swabs of other patients and the number of VRE positive cases increased to 11 on the 18th day. No VRE were detected in the environmental samples. By strict adherence and compliance to isolation precautions, physical separation of VRE positive newborns and healthcare workers and education of the personnel, VRE colonization was eradicated on the 55th day. During the period between the first detection of VRE colonization and the management of eradication (August 10th-October 4th 2009), 133 patients were followed up in the NICU and 52 (40%) of those patients were colonized by VRE. Patients were divided into two groups according to the presence or absence of VRE colonization. These patients' anthropometric and clinical findings were evaluated retrospectively. Gestational age and birth weights of VRE positive and negative patients were 30.9 ± 3.8 weeks and 1441 ± 543 g; 34.5 ± 4 weeks and 2396 ± 917 g, respectively (p< 0.05). VRE colonization was detected on the postnatal 16th day (days between 2-144). VRE became negative in 10 (19.2%) of the 52 colonized patients during follow-up in the hospital. None of the patients developed infection or sepsis due to VRE and no fatal case was detected. Mean durations of mechanical ventilation, hospitalization and antibiotic therapy were 15 (1-102) days, 34 (6-201) days and 23 (7-90) days, respectively in VRE positive patients, whereas those data were 3 (1-40) days, 9 (1-106) days and 10 (1-42) days in VRE negative patients. Antibiotic use (especially cephalosporins), days on mechanical ventilation and length of hospitalization were found significantly higher in VRE positive patients (p< 0.05) than those negatives, statistically. According to multiple variance analysis, the factor which independently affected VRE development was "duration of vancomycin use" [p= 0.04, OR = 0.67, CI (95%) = 0.45-0.98]. VRE colonization is seen more frequently in newborns who have medical problems during follow-up. Therefore surveillance cultures that performed routinely in NICUs, would be helpful to detect VRE colonization in time and to implement isolation precautions rapidly in order to prevent dissemination of the organism and decrease the incidence of bacteremia and death.
authors.affiliation: Zeynep Kamil Obstetric and Pediatric Diseases Training and Research Hospital, İstanbul, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Benzer
authors.forename: Dilek
authors.initials: D
authors.lastname: Yavuzcan Öztürk
authors.forename: Tuğba
authors.initials: T
authors.lastname: Gürsoy
authors.forename: Mutlu Seyda
authors.initials: MS
authors.lastname: Ocalmaz
authors.forename: Güner
authors.initials: G
authors.lastname: Karatekin
authors.forename: Hüsnü Fahri
authors.initials: HF
authors.lastname: Ovalı
mesh_terms: D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000517:prevention & control*; D006282:Health Personnel / Q000193:education; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000382:microbiology / Q000517:prevention & control*; D007363:Intensive Care Units, Neonatal; D010356:Patient Isolation; D016635:Universal Precautions; D020713:Vancomycin Resistance