VRE transmitted to neonatal ICU from adult inpatients

Issue: March 2014

MEMPHIS, Tenn. — Adult inpatients can introduce endemic strains of vancomycin-resistant Enterococcus faecium into the neonatal ICU resulting in transmission, according to data presented at the St. Jude/PIDS Pediatric Infectious Diseases Research Conference.

Perspective from Richard F. Jacobs, MD

In May 2010, an endemic strain of vancomycin-resistant E. faecium (VRE) among adult inpatients resulted in a controlled neonatal ICU outbreak at Parkland Health and Hospital System in Dallas.

Natasha W. Hanners, MD, of the University of Texas Southwestern Medical Center, and colleagues evaluated 233 infants who had at least one surveillance culture for VRE performed in the neonatal ICU during the outbreak to determine the clinical characteristics of those colonized with VRE and the risk factors associated with VRE colonization.

Natasha W. Hanners

Overall, 6% of patients were colonized with VRE. The index patient was aged 27 days with a positive urine culture for VRE.

Rooms were separated for patients into VRE-positive (contact precautions used), VRE-exposed and VRE-unexposed.

Patients who were VRE-colonized were more likely to be lower birth weight, older age, spent more days in acute or continuing care, had longer used of nasogastric tubes and received more days of expressed breast milk. No difference was found among patients for antibiotic days, including receipt of vancomycin.

Overall, no patients developed VRE infection and no patients died.

“In terms of outbreaks, you don’t know what’s there if you’re not looking for it,” Hanners told Infectious Diseases in Children. “Second of all, as with any outbreak, you have to stress the importance or monitoring multidrug-resistant organisms and having strict adherence and reeducation about contact precautions and making sure to use standard precautions for all patients at all times. – by Amber Cox

For more information:

Hanners NW. Abstract 201427. Presented at: St. Jude/PIDS Pediatric Infectious Diseases Research Conference 2014; Feb. 21-22, 2014; Memphis, Tenn.

Disclosure: The researchers report no relevant financial disclosures.

Perspective

Richard F. Jacobs, MD

Vancomycin-resistant Enterococcus faecium (VRE) colonization continues to plague inpatient units sporadically in health care settings. The findings in this study are consistent with other findings published previously. The longer a patient resides in an inpatient unit of a hospital that has proven VRE patients (colonized or infected), the greater the risk of VRE spread. These neonatal ICU findings also highlight several known risk factors for acquiring VRE, such as use of nasogastric tubes or other medical devices that are known to be associated with VRE colonization. The difficulty of eliminating VRE among hospitalized patients and colonized health care workers and hospital equipment/devices continues to emphasize prevention and judicious use of antibiotics in today’s health care environment.

Richard F. Jacobs, MD

Infectious Diseases in Children Chief Medical Editor

Disclosures: Jacobs reports no relevant financial disclosures.