Third Department of Pediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece.
Am J Infect Control. 2013 Oct;41(10):857-61. doi: 10.1016/j.ajic.2013.02.005. Epub 2013 May 11.
Vancomycin-resistant Enterococcus faecium (VRE) may cause outbreaks in neonatal intensive care units (NICU). We describe a biphasic VRE outbreak and identify risk factors for VRE acquisition.
After the occurrence of 2 cases of VRE infections in a 44-bed NICU, a bundle of interventions was implemented that included active surveillance cultures for VRE, enhanced infection control measures, and audits on antimicrobial use, from June to December 2008. Analysis was performed using polymerase chain reaction and pulse-field gel electrophoresis techniques. A case-control study was conducted to identify risk factors.
Among 253 neonates screened, 101 (39.9%) were found to be colonized with VRE. During the first 9 weeks of the study period, 59 new cases were detected. Molecular analysis showed 1 predominant clone. During weeks 10-12, no new cases of VRE colonization were detected; however, at week 13, just when the outbreak appeared to be over, a second wave occurred, with 42 new cases and multiple clones detected. Multivariate analysis identified administration of antimicrobial therapy for late-onset neonatal sepsis and hospitalization during the first month of this outbreak as significant risk factors for VRE colonization.
Both a high prevalence of VRE colonization and antimicrobial use promoted the transmission of VRE during this biphasic outbreak. Adherence to infection control measures and antimicrobial stewardship policies are of utmost importance.
耐万古霉素粪肠球菌（VRE）可能在新生儿重症监护病房（NICU）引起暴发。我们描述了 VRE 的两阶段暴发，并确定了 VRE 获得的危险因素。
在 44 张床位的 NICU 中发生了 2 例 VRE 感染后，从 2008 年 6 月至 12 月，实施了包括 VRE 主动监测培养、加强感染控制措施和抗菌药物使用审核在内的一整套干预措施。使用聚合酶链反应和脉冲场凝胶电泳技术进行分析。进行了病例对照研究以确定危险因素。
在筛查的 253 名新生儿中，有 101 名（39.9%）被发现定植了 VRE。在研究期的前 9 周中，发现了 59 例新病例。分子分析显示存在 1 个主要克隆。在第 10-12 周，未检测到新的 VRE 定植病例；然而，当暴发似乎结束时，在第 13 周，出现了第二次浪潮，检测到 42 例新病例和多个克隆。多变量分析确定了在本次暴发的第一个月内针对晚发性新生儿败血症的抗菌药物治疗和住院治疗是 VRE 定植的重要危险因素。
VRE 定植的高患病率和抗菌药物的使用都促进了 VRE 在这两次暴发中的传播。遵守感染控制措施和抗菌药物管理政策至关重要。
