Management of vancomycin-resistant enterococci colonization in a neonatal intensive care unit: lessons from an outbreak.

Abstract

Objective: Vancomycin-resistant enterococci (VRE) have emerged as important causes of nosocomial infections in high-risk patients. Asymptomatic VRE colonized patients may act as potential reservoirs for other patients via hands. Infectious agents can spread rapidly within the same hospital. NICU are accepted to be at high-risk in terms of VRE colonization. We aimed to present our experience of a VRE colonization outbreak in the level-II NICU in 2010 and share the lessons we took from management of an outbreak. Methods: Rectal swab samples were collected from 506 infants following isolation of VRE from the index case and VRE colonization ratio was calculated. Active surveillance studies were sustained to determine the colonization ratios after the implementation of infection control measures. Results: A total of 3163 rectal swab samples were collected from 1155 infants. The VRE colonization ratio was calculated as 0.6% (n=7). Conclusion: It’s important to be aware of VRE colonization in hospitalized patients both for preventing sepsis, and for taking necessary infection control measures. Results of active surveillance studies in NICUs indicate a VRE colonization ratio of 0.5-2.2%. With the help of strict isolation measures and surveillance studies that we had implemented immediately after VRE isolation, we managed to get the outbreak under control in a short period of time. Glycopeptides have become irrevocable agents for late-onset sepsis of the newborn. VRE positivity was found to be 8.1% during the outbreak. Despite the modification of antibiotherapy protocols, we could reduce this ratio to 0.6% with the help of other precautions. We wanted to emphasize the restriction of unnecessary glycopeptide usage and the importance of strict adherence to infection control measures, especially handwashing and isolation.