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Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention.

Abstract
The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE) outbreak in a tertiary-care pediatric intensive care unit (PICU) of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75% reduction), and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.
AuthorsF Carmona, S I Prado, M F I Silva, G G Gaspar, F Bellissimo-Rodrigues, R Martinez, A K Matsuno, A P C P Carlotti
JournalBrazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas (Braz J Med Biol Res) Vol. 45 Issue 2 Pg. 158-62 (Feb 2012) ISSN: 1414-431X [Electronic] Brazil
PMID22267005 (Publication Type: Journal Article)
Chemical References
  • Anti-Bacterial Agents
  • Vancomycin
Topics
  • Anti-Bacterial Agents (administration & dosage)
  • Child
  • Cross Infection (epidemiology, microbiology, prevention & control)
  • Disease Outbreaks
  • Enterococcus (drug effects)
  • Female
  • Gram-Positive Bacterial Infections (epidemiology, microbiology, prevention & control)
  • Hospitals, University
  • Humans
  • Infection Control (methods)
  • Intensive Care Units, Pediatric
  • Male
  • Program Evaluation
  • Retrospective Studies
  • Vancomycin (administration & dosage)
  • Vancomycin Resistance

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