title: Vancomycin-resistant enterococci colonization in a neonatal intensive care unit: who will be infected?
abstract: OBJECTIVE
  To determine the incidence of vancomycin-resistant enterococcus (VRE) colonization in our neonatal intensive care unit (NICU) over five-year period, rate of progression to VRE infection and associated risk factors.
  
  
  METHODS
  A retrospective analysis of a prospective surveillance for VRE colonization and health care-associated infections was made. Contact precautions were taken against colonization, although the application varied over the years due to repairs in the unit.
  
  
  RESULTS
  VRE rectal colonization was detected in 200/1671 neonates (12%) admitted to NICU. It showed great interannual variability from 1.9% to 30.3%. Sytemic VRE infection developed in 6/200 VRE-colonized patients (3%) within a median of 9 days (range: 3-58 days). The risk factors for VRE infection development identified in the univariate analysis were long hospital stay (≥30 days), necrotizing enterocolitis, surgical procedure, extraventricular drainage, receipt of amphotericin B and receipt of glycopeptides after detection of VRE colonization. Crude in-hospital mortality was higher in neonates who developed a systemic VRE infection (p < 0.001).
  
  
  CONCLUSIONS
  Maintaining physical conditions in the unit favorable for infection control and rational use of antibiotics are essential in the control of VRE colonization and resultant infections. Special attention should be directed to VRE-colonized babies carrying the risk factors.
authors.affiliation: a Department of Paediatric Infectious Diseases , Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey .
authors.forename: Hacer
authors.initials: H
authors.lastname: Akturk
authors.affiliation: a Department of Paediatric Infectious Diseases , Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey .
authors.forename: Murat
authors.initials: M
authors.lastname: Sutcu
authors.affiliation: a Department of Paediatric Infectious Diseases , Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey .
authors.forename: Ayper
authors.initials: A
authors.lastname: Somer
authors.affiliation: a Department of Paediatric Infectious Diseases , Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey .
authors.forename: Manolya
authors.initials: M
authors.lastname: Acar
authors.affiliation: b Department of Clinical Microbiology , Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey .
authors.forename: Bahar
authors.initials: B
authors.lastname: Akgun Karapınar
authors.affiliation: b Department of Clinical Microbiology , Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey .
authors.forename: Derya
authors.initials: D
authors.lastname: Aydin
authors.affiliation: c Hospital Infection Control Committee, Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey , and.
authors.forename: Rukiye
authors.initials: R
authors.lastname: Cihan
authors.affiliation: d Department of Neonatology , Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Ince
authors.affiliation: d Department of Neonatology , Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey.
authors.forename: Asuman
authors.initials: A
authors.lastname: Çoban
authors.affiliation: a Department of Paediatric Infectious Diseases , Istanbul Medical Faculty, Istanbul University , Istanbul , Turkey .
authors.forename: Nuran
authors.initials: N
authors.lastname: Salman
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016022:Case-Control Studies; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology / Q000635:transmission*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000635:transmission*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000009:adverse effects; D065507:Vancomycin-Resistant Enterococci
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Colonization; glycopeptides; infection; neonatal intensive care unit; vancomycin-resistant enterococci