Peracchi Francesco, Travi Giovanna, Proto Alice, Nicolini Elena, Busni Andrea, Mezzadri Luca, Tartaglione Livia, Bielli Alessandra, Matarazzo Elisa, Casalicchio Giorgia, Del Curto Cecilia, Rossotti Roberto, Merli Marco, Vismara Chiara, Crippa Fulvio, Martinelli Stefano, Puoti Massimo
School of Medicine and Surgery, University of Milano-Bicocca, Piazza Dell'Ateneo Nuovo 1, 20126 Milano, Italy.
Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore 3, 20162 Milan, Italy.
Microorganisms. 2025 Apr 4;13(4):822. doi: 10.3390/microorganisms13040822.
Vancomycin-resistant enterococci (VRE) are a major cause of healthcare-associated infections (HAIs). However, the clinical significance of VRE colonization and the subsequent risk of VRE infection in hospitalized patients are not fully established. Prolonged hospital stays have been observed in neonates colonized by VRE. The mortality rate in pediatric patients with VRE infections ranges from 0% to 42% in both endemic and outbreak settings, often occurring in VRE-colonized neonates. Host and bacterial factors associated with a worse outcome are not fully understood yet. We describe an outbreak of VRE colonization in 21 newborns admitted to our neonatal intensive care unit in January 2024. Microbiological analyses on rectal swabs were performed using molecular testing and culture. Results: In January, VRE was first detected in the urine culture of a 3-week-old patient, followed by a subsequent positive rectal swab result. In accordance with our infection control policy, all the NICU patients were tested, leading to the identification of another 12 colonized patients. The implementation of molecular testing led to rapid VRE identification and the subsequent isolation of colonized neonates, which promptly contained the outbreak. The median time from NICU admission to colonization was 34 (6-37) days. Only one patient developed a CVC-related bloodstream infection, which was successfully treated with linezolid and CVC removal. No VRE-related deaths occurred, even among three patients who underwent abdominal surgery (one gastroschisis, one incarcerated abdominal hernia, and one umbilical hernia) and one patient with necrotizing enterocolitis. Our data show a low infection rate (4%) among VRE-colonized patients (4%) during a NICU outbreak. The rapid identification of multidrug-resistant genes by molecular testing may be implemented in specific settings to enable timely patient identification, adopt infection control measures, and administer appropriate antimicrobial therapy.
耐万古霉素肠球菌（VRE）是医疗保健相关感染（HAIs）的主要原因。然而，VRE定植的临床意义以及住院患者随后发生VRE感染的风险尚未完全明确。在VRE定植的新生儿中观察到住院时间延长。在地方流行和暴发情况下，VRE感染的儿科患者死亡率在0%至42%之间，且常发生在VRE定植的新生儿中。与不良结局相关的宿主和细菌因素尚未完全了解。我们描述了2024年1月入住我们新生儿重症监护病房的21例新生儿中发生的VRE定植暴发。使用分子检测和培养对直肠拭子进行微生物学分析。结果：1月，在一名3周龄患者的尿培养中首次检测到VRE，随后直肠拭子检测结果呈阳性。根据我们的感染控制政策，对所有新生儿重症监护病房患者进行了检测，又发现了另外12例定植患者。分子检测的实施导致快速鉴定出VRE并随后隔离定植的新生儿，迅速控制了暴发。从入住新生儿重症监护病房到定植的中位时间为34（6 - 37）天。只有一名患者发生了与中心静脉导管（CVC）相关的血流感染，通过利奈唑胺治疗并拔除CVC后成功治愈。即使在三名接受腹部手术（一名腹裂、一名嵌顿性腹疝和一名脐疝）的患者以及一名坏死性小肠结肠炎患者中，也未发生与VRE相关的死亡。我们的数据显示，在新生儿重症监护病房暴发期间，VRE定植患者中的感染率较低（4%）。在特定环境中可实施通过分子检测快速鉴定多重耐药基因，以便及时识别患者、采取感染控制措施并给予适当的抗菌治疗。
