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Control of Vancomycin-Resistant Enterococci in the Neonatal Intensive Care Unit

Published online by Cambridge University Press:  21 June 2016

Nalini Singh ,
Marie-Michèle Léger ,
Joyce Campbell ,
Billie Short  and
Joseph M. Campos
Nalini Singh*
Affiliation:
Department of Pediatrics, George Washington University School of Medicine, Washington, DC Department of Epidemiology, School of Public Health and Health Services, George Washington University, Washington, DC Division of Infectious Disease-Hospital Epidemiology Program, Washington, DC
Marie-Michèle Léger
Affiliation:
Department of Health Care Sciences, George Washington University School of Medicine, Washington, DC Division of Infectious Disease-Hospital Epidemiology Program, Washington, DC
Joyce Campbell
Affiliation:
Division of Infectious Disease-Hospital Epidemiology Program, Washington, DC
Billie Short
Affiliation:
Department of Pediatrics, George Washington University School of Medicine, Washington, DC Division of Neonatology, Washington, DC
Joseph M. Campos
Affiliation:
Department of Pediatrics, George Washington University School of Medicine, Washington, DC Departments of Pathology and Microbiology/Tropical Medicine, Washington, DC Department of Laboratory Medicine, Children's National Medical Center, Washington, DC
*
Epidemiology and International Health, George Washington University, Schools of Medicine and Public Health, Children's National Medical Center, 111 Michigan Ave. N. W., Washington, DC 20010.Nsingh@cnmc.org
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Abstract

Background and Objective:

Multidrug-resistant organisms (MDROs), such as vancomycin-resistant enterococci (VRE), cause serious infections, especially among high-risk patients in NICUs. When VRE was introduced and transmitted in our NICU despite recommended infection control practices, we instituted active surveillance cultures to determine their efficacy in detecting and controlling spread of VRE among high-risk infants.

Methods:

Active surveillance cultures, other infection control measures, and a mandatory in-service education module on preventing MDRO transmission were implemented. Cultures were performed on NICU admission and then weekly during their stay. Molecular DNA fingerprinting of VRE isolates facilitated targeting efforts to eliminate clonal spread of VRE. Repetitive sequence PCR (rep-PCR)-based DNA fingerprinting was used to compare isolates recovered from patients with VRE infection or colonization. Environmental VRE cultures were performed around VRE-colonized or -infected patients. DNA fingerprints were prepared from the products of rep-PCR amplification and analyzed using software to determine strain genetic relatedness.

Results:

Active surveillance cultures identified 65 patients with VRE colonization or infection among 1,820 admitted to the NICU. Rep-PCR performed on 60 VRE isolates identified 3 clusters. Cluster 1 included isolates from 21 patients and 4 isolates from the environment of the index patient. Clusters 2 and 3 included isolates from 23 and 3 patients, respectively. Similarity coefficients among the members of each cluster were 95% or greater.

Conclusions:

Control of transmission of multi-clonal VRE strains was achieved. Active surveillance cultures, together with implementation of other infection control measures, combined with rep-PCR DNA fingerprinting were instrumental in controlling VRE transmission in our NICU. (Infect Control Hosp Epidemiol 2005;26:646-649)

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 7 , July 2005 , pp. 646 - 649
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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