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

Brazilian Journal of Medical and Biological Research

F. Carmona²  S.i. Prado¹  M.f.i. Silva¹  G.g. Gaspar¹  F. Bellissimo-rodrigues¹  R. Martinez¹  A.k. Matsuno²  A.p.c.p. Carlotti² 

[1] ,Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Hospital das ClínicasRibeirão Preto SP ,Brasil

关键词: Infections;    Antibiotics misuse;    Drug resistance;    Vancomycin-resistant enterococcus;   

DOI  :  10.1590/S0100-879X2012007500005

来源: SciELO

【 摘 要 】

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.

【 授权许可】

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