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Vancomycin-Resistant Enterococci
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Like commensal enterococci, VRE mainly colonize the gastrointestinal tract, but can also be found on the skin. Perhaps the latter is, in part, attributable to hygienic factors. It is therefore unsurprising that direct transmission occurs through contaminated hands of healthcare workers. VRE are indirectly transmitted by contaminated medical equipment and contaminated environment. In fact, VRE can be found in the environment for weeks to months. Finally, diarrhoea further increases transmission. Duration of carriage can be anywhere between weeks and years, with 3 years or longer described.
Colonization, Infection, and Resistance in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Colonization pressure in hospitals can result in increased transmission [34]. The hospital environment can be heavily colonized with VRE. Transmission of VRE from environmental surfaces to hands or gloves of healthcare professionals (HCPs) has been well-documented [35]. Exposure to contaminated surfaces, even after routine disinfection, can be associated with VRE acquisition. Hospitalization in a room previously occupied by a patient colonized with VRE can also be associated with increased risk of VRE acquisition [36].
0 Introduction
Published in Rick Iedema, Katherine Carroll, Aileen Collier, Su-yin Hor, Jessica Mesman, Mary Wyer, Video-Reflexive Ethnography in Health Research and Healthcare Improvement, 2018
Rick Iedema, Katherine Carroll, Aileen Collier, Su-yin Hor, Jessica Mesman, Mary Wyer
The field of healthcare improvement includes endeavours as varied as patient safety research, quality of care research, clinical practice improvement, health service research, health policy reform and implementation science. This book keys in to this array of endeavours in the following ways: first, without tying itself to any one of these types of research and improvement, VRE may unfold in ways that have relevance for one or more of the endeavours just listed. This is because VRE is agnostic about how to label an aspect of practice on which front-line professionals and their researchers or facilitators may decide to concentrate. Using VRE to address different staff members’ understandings about and approaches to using clean and sterile gloves, for example, may have relevance for patients’ safety, for the implementation of infection control (and hand hygiene) guidelines, for practice improvement and so on.
Increasing trend in enterococcal bacteraemia and vancomycin resistance in a tertiary care hospital in Croatia, 2017–2021
Published in Infectious Diseases, 2023
Zrinka Todorić, Ivana Majdandžić, Tea Keretić Kregar, Zoran Herljević, Mario Ćorić, Joško Lešin, Tomislav Kuliš, Ivana Mareković
Increases and differences in enterococcal bacteraemia and vancomycin resistance are probably associated with infection control policies and differences in use of antimicrobial agents. Carbapenems, broad-spectrum cephalosporins, vancomycin and ciprofloxacin are associated with acquisition of vancomycin resistance [7,29]. Use of vancomycin for surgical prophylaxis and failure to de-escalate to a suitable narrow-spectrum antibiotic contribute to the emergence of resistance [27,30]. Infection control strategies to prevent the spread and acquisition of VRE in hospital settings include contact precautions, hand hygiene, environmental cleaning and active screening of at-risk patients. Some authors emphasise the importance of hand hygiene, surface cleaning and disinfection but question the necessity of contact isolation to prevent VRE acquisition [30–32].
Structure-activity relationship studies for inhibitors for vancomycin-resistant Enterococcus and human carbonic anhydrases
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2022
Weiwei An, Katrina J. Holly, Alessio Nocentini, Ryan D. Imhoff, Chad. S. Hewitt, Nader S. Abutaleb, Xufeng Cao, Mohamed N. Seleem, Claudiu T. Supuran, Daniel P. Flaherty
Vancomycin-resistant enterococci (VRE) is a member of the notorious group of drug-resistant ESKAPE pathogens1 and is considered a serious threat to public health by the Centres for Disease Control and Prevention2. VRE encompasses a host of Enterococcus species, facultative anaerobic Gram-positive bacteria that are able to withstand harsh conditions and colonise surfaces in healthcare settings3. The earliest report of VRE from 1899 revealed it as a leading cause of infective endocarditis4. Later studies also indicated that VRE is a leading cause of pelvic, neonatal and urinary tract infections (UTIs)5. In the 1970s, VRE primarily consisted of Enterococcus faecalis, which accounted for over 90% of clinical enterococcal isolates during the first wave of VRE infections6. However, since the 1990s, the leading causative agent of VRE has been Enterococcus faecium with now more than 70% of isolated strains being resistant to vancomycin6. Furthermore, VRE was responsible for a 10% mortality rate among nearly 55,000 reported cases in 20172,7. However, the mortality rate climbs for those with systemic blood-stream infections reaching as high as 30%8. Patients at high risk for VRE infection include those in long-term healthcare facilities, intensive care unit patients, organ transplant patients and patients with weakened immune systems.
Open-label prospective therapeutic clinical trials: oral vancomycin in children and adults with primary sclerosing cholangitis
Published in Scandinavian Journal of Gastroenterology, 2020
Ahmad Hassan Ali, Jennifer Damman, Shamita B. Shah, Yinka Davies, Melissa Hurwitz, Mariam Stephen, Leta M. Lemos, Elizabeth J. Carey, Keith D. Lindor, Cynthia W. Buness, Leina Alrabadi, William E. Berquist, Kenneth L. Cox
We recognize that we likely did not identify all patients with PSC-AIH overlap, and therefore our results may not be applicable to this subgroup. Liver biochemistry fluctuates in patients with PSC; therefore, whether the biochemical improvement observed in our studies is related to the natural history of PSC or treatment with OV is unknown. Liver chemistry analyses in our study were performed at 1–2 months intervals; future studies evaluating OV in PSC studies should consider liver biochemistry measurement at narrower intervals to better understand the dynamic changes in liver biochemistry in relation to OV. PSC patients without biochemical evidence of cholestasis are often not included in therapeutic clinical trials, largely due the perception that such patients have better outcomes. Our finding that more than one-half of those with normal GGT (who also had normal ALP) at the time of OV treatment had evidence of fibrosis stage 2 or higher suggests that these patients are at high risk for serious events; therefore, more accurate biomarkers for prognostication are urgently needed. Although no patient reported symptoms or signs indicative of VRE infection, this finding should be interpreted with caution. A standardized VRE surveillance protocol was not in place, and thus the true rates of VRE in our study patients is unknown.