MRSA, Staph, Staff, Mersa, Methicillin Resistant Staphylococcus Aureus Symptoms & Treatment

Outbreak of hospital-adapted VRE

Link: Outbreak of hospital-adapted clonal complex-17 vancomycin-resistant Enterococcus faecium strain in a haematology unit: role of rapid typing for early control -- Deplano et al. 60 (4): 849 -- Journal of Antimicrobial Chemotherapy.

To describe the investigation and molecular characterization of a vancomycin-resistant Enterococcus faecium (VREF) strain responsible for a nosocomial outbreak in the haematology unit of a tertiary-care university hospital. Patients and methods: Two patients admitted to the haematology unit developed infection/colonization with VREF over a 3 month period when compared with none in the 2 previous years. On the basis of the identification of a clonal link between these two strains, weekly rectal screening was implemented for all patients in the haematology unit and contact precautions were extended to VREF carriers. In the following 6 month period, 11 patients colonized with VREF were detected. No further case was detected in the following 1 year period. Results: VREF isolates from the haematology unit carried the vanA gene and were multiresistant to antimicrobial agents, including high-level resistance to vancomycin, teicoplanin and ampicillin. This resistance profile restricted the choice of antimicrobial therapy to linezolid or investigational drugs such as tigecycline. Molecular analysis showed that 11 of 13 (85%) VREF isolates belonged to pandemic clonal complex-17 carrying the esp and hyl virulence genes. Conclusions: Rapid typing and infection control measures, including early reinforcement of barrier precautions combined with weekly rectal surveillance cultures, were followed by control of nosocomial spread of this VREF clone.

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Using Vancomycin before Surgery and monitoring VRE

Link: The Annals of Pharmacotherapy.

       OBJECTIVE: To determine the tolerance of vancomycin for antibiotic prophylaxis and incidence of vancomycin-resistant Enterococcus (VRE) in cardiac surgery patients. METHODS: In 2 separate studies, we assessed the adverse effects in patients given perioperative vancomycin (study 1) and the incidence of VRE in patients given perioperative vancomycin (study 2). Study 1 was a prospective cohort study of patients undergoing coronary artery bypass graft (CABG) or valve replacement surgery given vancomycin (1 dose preoperatively/2 doses postoperatively) for antibiotic prophylaxis between October 2003 and December 2004. Patients were assessed for tolerance to the antibiotic regimen. In study 2, cardiac surgery patients receiving perioperative vancomycin were screened for VRE before therapy and at day 7 of hospitalization. VRE was detected using standard microbiologic procedures. RESULTS: In study 1, 1161 patients (CABG = 75%; valve = 19%; both = 6%) were evaluated. All patients but one (99.9%) were prescribed preoperative vancomycin. Therapy was changed for 34 (2.9%) patients, of which 20 changes were due to physician preference for another antibiotic. The only toxicity that required a change in the vancomycin regimen was red man's syndrome, which was experienced by 9 (0.8%) patients. Four patients did not receive a second postoperative dose due to prior renal insufficiency. Patients were most commonly switched to cefuroxime (n = 26), linezolid (n = 2), cefepime (n = 2), gatifloxacin, cefazolin, levofloxacin, or ceftriaxone (n = 1, each). In study 2, 100 patients were screened for the emergence of VRE colonization. No patient was VRE positive at baseline and 4 (4%) were positive at day 7. CONCLUSIONS: Surgical antibiotic prophylaxis with vancomycin was reasonably well tolerated in CABG and valve replacement surgery, with a 4% incidence of VRE colonization.

VRE Action Needed Says Scottish MP

Link: Evening Telegraph: News.

Efforts to tackle a potentially fatal superbug in Scots hospitals could be thwarted by inadequate staffing levels and poor infection control measures, writes Graeme Strachan. Dundee MSP Shona Robison welcomed measures put in place by the Scottish Executive to combat the growing spread of vancomycin-resistant enterococci (VRE) in hospitals. However, the SNP’s health spokeswoman expressed concern at the potential for infection with staff having to “rush” their work due to inadequate staffing levels. She’s also worried that, as some NHS boards have a higher success rate with infection control measures than others, there could be a lack of consistency in tackling VRE in hospitals. Last year there were 500 cases of VRE in Scotland, which breaks down the body’s resistance to other bacteria and can lead to illnesses such as septicaemia and pneumonia. The Scottish Executive has launched a �15m campaign to counter VRE and other hospital bugs.

Hospital limits visits during superbug outbreak

Link: CTV.ca

The Queen Elizabeth II Health Sciences Centre in Halifax, N.S. is attempting to contain an outbreak of bacteria resistant to most common antibiotics. VRE is a rather routine bacteria, but what isn't routine at the region's largest hospital is the number of patients who are carrying it. At least 17 patients in five different units at the QEII Health Sciences Centre have been found to be carrying the bacteria. None have become ill or developed any infections resulting from it, but they've been placed in isolation to prevent further spread of the bug. Vancomycin-Resistant Enterococci (VRE) infections aren't necessarily more dangerous than other bugs in hospital, but the fact that they can't be treated with antibiotics makes them a problem.