title: Healthcare-associated vancomycin resistant Enterococcus faecium infections in the Mansoura University Hospitals intensive care units, Egypt.
abstract: Vancomycin resistant Enterococcus faecium (VREF) ia an emerging and challenging nosocomial pathogen. This study aimed to determine the prevalence, risk factors and clonal relationships between different VREF isolates in the intensive care units (ICUs) of the university hospitals in our geographic location. This prospective study was conducted from July, 2012 until September, 2013 on 781 patients who were admitted to the ICUs of the Mansoura University Hospitals (MUHs), and fulfilled the healthcare-associated infection (HAI) criteria. Susceptibility testing was determined using the disk diffusion method. The clonal relationships were evaluated with pulsed field gel electrophoresis (PFGE). Out of 52 E. faecium isolates, 12 (23.1%) were vancomycin resistant. The significant risk factors for the VREF infections were: transfer to the ICU from a ward, renal failure, an extended ICU stay and use of third-generation cephalosporins, gentamicin, or ciprofloxacin. PFGE with the 12 isolates showed 9 different patterns; 3 belonged to the same pulsotype and another 2 carried a second pulsotypes. The similar pulsotypes isolates were isolated from ICUs of one hospital (EICUs); however, all of the isolates from the other ICUs had different patterns. Infection control policy, in conjunction with antibiotic stewardship, is important to combat VREF transmission in these high-risk patients.
authors.affiliation: Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt .
authors.forename: Dalia
authors.initials: D
authors.lastname: Moemen
authors.affiliation: Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt .
authors.forename: Doaa
authors.initials: D
authors.lastname: Tawfeek
authors.affiliation: Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt .
authors.forename: Wafaa
authors.initials: W
authors.lastname: Badawy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004269:DNA, Bacterial / Q000235:genetics; D004534:Egypt / Q000453:epidemiology; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification; D005839:Gentamicins / Q000627:therapeutic use; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D051437:Renal Insufficiency; D012307:Risk Factors; D014640:Vancomycin / Q000627:therapeutic use*; D020713:Vancomycin Resistance / Q000502:physiology*; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004269:DNA, Bacterial; D005839:Gentamicins; D002939:Ciprofloxacin; D014640:Vancomycin
keywords: Enterococcus faecium; ICU; PFGE; risk factors; vancomycin