Infection Control and Hospital Epidemiology
نویسنده
چکیده
Enterococci have caused infections in hospitalized patients for many decades. Given that they were part of the normal flora of the gastrointestinal (GI) tract and that they frequently appeared as part of the flora in infections related to fecal contamination, they originally were considered endogenous pathogens of little nosocomial import This view began to change with the appearance of enterococci resistant to vancomycin in Europe in 1988. Vancomycin resistance appeared subsequent to earlier reports of enterococci resistant to pencillin and aminoglycosides, raising the concern that infections caused by vancomycin-resistant enterococci (VRE) might be difficult, if not impossible, to treat. A 1993 report from the National Nosocomial Infection Surveillance system at the Centers for Disease Control and Prevention (CDC) indicated that VRE had appeared in the United States and had increased from 0.3% of nosocomial enterococci in 1989 to 7.9%. The change was even more dramatic for enterococcal isolates in intensive care units, where VRE had increased in the same period from 0.4% to 13.6%, a 34-fold increase in the 4-year period. During the period covered by that report, six VRE outbreaks were reported in the literature." In 1994, three more publications described outbreaks of VRE. These studies during the first 5 years of the VRE epidemic (19891994) began to define the epidemiology of VRE colonization and infection and led to the following conclusions: • VRE colonize or infect very ill and immunocompromised patients (intensive care, oncology, and transplant patients). • The GI tract is the most important reservoir. • VRE contaminate patients' environments. • Environmental contamination is increased when patients have diarrhea. • VRE may be transmitted by medical instruments. • Prolonged hospital stay increases the risk for acquiring VRE. • Exposure to cephalosporins and vancomycin may increase the risk of colonization by VRE. • Close proximity to a VRE-positive patient and being cared for by a nurse caring for a VRE-positive patient increases the risk for acquisition of VRE. • Resistance in VRE is transferable. • Although not frank pathogens, VRE can cause invasive disease associated with morbidity and possibly mortality. Presently, the rising epidemic of VRE, the limited or absent therapeutic options for treating serious VRE infections, and a concern that the resistance genes in VRE might be transferred to other gram-positive microorganisms such as Staphylococcus aureus led the CDC to publish recommendations from the Hospital Infection Control Practices Advisory Committee for preventing the spread of vancomycin resistance. These recommendations were developed using data from studies published during the first 5 years of the VRE epidemic. The recommendations provided guidelines for the prudent use of vancomycin, recommended educational programs for hospital staff regarding the epidemiology and control of VRE, defined the role of the hospital microbiology laboratory, and outlined an approach for the prevention and control of VRE. Recommendations for control included culture surveys to identify patients colonized with VRE, barrier precautions, environmental decontamination, and establishment of a mechanism to ensure that VRE carriers were placed on Isolation Precautions immediately on readmission to the hospital. Since publication of these recommendations, VRE have continued to spread, and the epidemic has not been controlled. In the second 5 years of the epidemic (1994 to the present), only modest additional contributions have been made to our understanding of the epidemiology and control of VRE.
منابع مشابه
Prevalence and epidemiology of hepatitis C virus (HCV) infection in Rafsanjan
Abstract Background: Many individuals with chronic hepatitis C virus (HCV) infection are asymptomatic, population-based serologic studies are needed to estimate the prevalence of infection which will help to take necessary procedures for prevension and control the disease.This study was conducted to find out the prevalence, of HCV infection among patients refering to the hospit...
متن کاملPreventing catheter-associated urinary tract infections: hospital location of catheter insertion.
Infection Control & Hospital Epidemiology / Volume 33 / Issue 10 / October 2012, pp 1057 1058 DOI: 10.1086/667771, Published online: 02 January 2015 Link to this article: http://journals.cambridge.org/abstract_S0195941700031842 How to cite this article: David J. Weber, JaHyun Kang, Vickie M. Brown, Emily E. Sickbert-Bennett and William A. Rutala (2012). Preventing Catheter-Associated Urinary Tr...
متن کاملRequirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Society for Healthcare Epidemiology of America.
The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have...
متن کاملAPIC/CHICA-Canada/CBIC infection prevention, control and epidemiology: professional and practice standards.
The Association for Professionals in Infection Control and Epidemiology, Inc (APIC) and the Community and Hospital Infection Control Association-Canada (CHICA-Canada) collaborated to craft this document, Infection prevention, control and epidemiology: Professional and practice standards. Both professional organizations affirm their responsibility to their memberships and the public they serve t...
متن کاملHospital costs in patients with nosocomial methicillin-resistant or methicillin-susceptible Staphylococcus aureus bloodstream infection.
Staphylococcus aureus Bloodstream Infection • Author(s): Dominique M. Vandijck, PhD; Lieven Annemans, PhD; Dirk P. Vogelaers, PhD; Stijn I. Blot, PhD Source: Infection Control and Hospital Epidemiology, Vol. 30, No. 11 (November 2009), p. 1127 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10....
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره شماره
صفحات -
تاریخ انتشار 2014