| 2. |
- Torell, Erik, et al.
(författare)
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Intrahospital spread of vancomycin-resistant Enterococcus faecium in Sweden
- 1997
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 29:3, s. 259-263
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Tidskriftsartikel (refereegranskat)abstract
- During a 17-week period vancomycin-resistant Enterococcus faecium (VRE) was found in clinical specimens from 4 in-patients. All bacterial isolates were phenotypically VanA, showing high-level resistance to vancomycin (MIC 256 micrograms/ml) and teicoplanin (MIC 24-256 micrograms/ml). The corresponding gene (vanA) was detected with PCR in strains from 3 of the patients. Three patients had been hospitalized at the renal unit at Orebro Medical Centre Hospital (OMCH). The fourth patient, diagnosed in another hospital, had received treatment in the oncology unit at OMCH. All patients recovered without treatment specific for VRE. Isolates from 2 patients were indistinguishable by pulsed-field gel electrophoresis of genomic DNA. Genetically, these strains were related to the VRE isolates from the 2 other patients. Screening of hospital staff and other in-patients for gastrointestinal carriage of VRE was negative. Glycopeptide-resistant enterococci have not previously been found in OMCH. No new cases were identified during a 10-month follow-up period. Our cases represent the first nosocomial outbreak of VRE in Sweden.
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| 4. |
- Torell, Erik, et al.
(författare)
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Near absence of VRE but high carriage rates of quinolone-resistant ampicillin-resistant enterococci among hospitalized patients and non-hospitalized individuals in Sweden
- 1999
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Ingår i: Journal of Clinical Microbiology. - 0095-1137 .- 1098-660X. ; 37:11, s. 3509-3513
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Tidskriftsartikel (refereegranskat)abstract
- Rates of colonization with enterococci with acquired resistance to vancomycin (vancomycin-resistant enterococci [VRE]) and ampicillin (ampicillin-resistant enterococci [ARE]) were determined by using fecal samples from 670 nonhospitalized individuals and 841 patients in 27 major hospitals. Of the hospitalized patients, 181 (21.5%) were carriers of ARE and 9 (1.1%) were carriers of VRE. In univariate analyses, length of hospital stay (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.5 to 8.9) and antimicrobial therapy (OR, 4.7; 95% CI, 3.3 to 6.7) were associated with ARE colonization, as were prior treatment with penicillins (OR, 3.1; 95% CI, 1.8 to 5. 5), cephalosporins (OR, 2.9; 95% CI, 1.7 to 5.0), or quinolones (OR, 2.7; 95% CI, 1.5 to 4.7). In logistic regression analysis, antimicrobial therapy for at least 5 days was independently associated with ARE carriage (adjusted OR, 3.8; 95% CI, 2.6 to 5.4). Over 90% of the ARE isolates were fluoroquinolone resistant, whereas 14% of the ampicillin-susceptible Enterococcus faecium isolates were fluoroquinolone resistant. ARE carriage rates correlated with the use of fluoroquinolones (P = 0.04) but not with the use of ampicillin (P = 0.68) or cephalosporins (P = 0.40). All nine VRE isolates were E. faecium vanB and were found in one hospital. Seven of these isolates were related according to their types as determined by pulsed-field gel electrophoresis. Among the nonhospitalized individuals, the ARE carriage rate was lower (6%; P < 0.05), and only one person, who had recently returned from Africa, harbored VRE (E. faecium vanA). The absence of VRE colonization in nonhospitalized individuals reflects an epidemiological situation in Sweden radically different from that in countries in continental Europe where glycopeptides have been widely used for nonmedical purposes.
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