Risk factors for intestinal colonization with vancomycin resistant enterococci’ A prospective study in a level III pediatric intensive care unit

Rajesh Amberpet; Sujatha Sistla; Subhash Chandra Parija; Ramachandran Rameshkumar

doi:10.4103/JLP.JLP_32_17

Journal of Laboratory Physicians, Table of Contents

CC BY-NC-ND 4.0 · J Lab Physicians 2018; 10(01): 089-094
DOI: 10.4103/JLP.JLP_32_17

Original Article

Risk factors for intestinal colonization with vancomycin resistant enterococci’ A prospective study in a level III pediatric intensive care unit

Rajesh Amberpet

Department of Microbiology, Division of Pediatric Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

,

Sujatha Sistla

Department of Microbiology, Division of Pediatric Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

,

Subhash Chandra Parija

Department of Microbiology, Division of Pediatric Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

,

Ramachandran Rameshkumar

Department of Pediatrics, Division of Pediatric Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

› Author Affiliations

Abstract

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Abstract

PURPOSE: Vancomycin-resistant enterococci (VRE) emerged as one of the major nosocomial pathogens across the globe. Gut colonization rate with VRE is higher in patients admitted to intensive care units (ICUs) due to the higher antibiotic pressure. VRE colonization increases the risk of developing infection up to 5–10 folds. The aim of this study was to determine the rates of VRE colonization among the patients admitted to pediatric ICU (PICU) and risk factors associated with it.

MATERIALS AND METHODS: Rectal swabs were collected after 48 h of admission to PICU from 198 patients. The samples were inoculated onto bile esculin sodium azide agar with 6 mg/ml of vancomycin. Growth on this medium was identified by the standard biochemical test, and minimum inhibitory concentration of vancomycin and teicoplanin was detected by agar dilution method. Resistance genes for vancomycin were detected by polymerase chain reaction. Risk factors were assessed by logistic regression analysis.

RESULTS: The rates of VRE colonization in patients admitted to PICU was 18.6%. The majority of the isolates were Enterococcus faecium (75.6%) followed by Enterococcus faecalis (24.4%). One patient acquired a VRE bloodstream infection (2.6%) among colonized patients, and none of the noncolonized patients acquired the infection. Consumption of vancomycin was found to be the only risk factor significantly associated with VRE colonization.

CONCLUSION: Routine surveillance and isolation of patients found to be VRE colonized may not be possible in tertiary care hospitals; however, educating health-care workers, promoting handwashing with antiseptic soaps or solutions, and antibiotic Stewardship policy may help in the reduction of vancomycin resistance and VRE colonization.

Keywords

Enterococcus faecalis - Enterococcus faecium - vancomycin-resistant enterococci - vancomycin-resistant enterococci - vancomycin-resistant enterococci colonization in Intensive Care Unit

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References

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