Emergence of VRE in a CVTS ICU: An active surveillance and molecular analysis

Dr Mudshingkar Swati; Dr Pol Sae; Dr Dhakephalkar Prashant; Dr Desai Shailaja; Dr Kongre Vaishali; Dr Bhardwaj Renu

Volume : VI, Issue : IX, September - 2017

Emergence of VRE in a CVTS ICU: An active surveillance and molecular analysis

Dr Mudshingkar Swati, Dr Pol Sae, Dr Dhakephalkar Prashant, Dr Desai Shailaja, Dr Kongre Vaishali, Dr Bhardwaj Renu

Abstract :

Introduction- We report an epidemiological survey of Vancomycin Resistant Enterococci (VRE) in Cardiovascular Thoracic Surgery (CVTS) Unit of tertiary care hospital. The survey was conducted after we isolated VRE, (the first case of VRE from our institute) , from blood culture of a patient of a 50 year-old man who presented with signs and symptoms of sepsis on 4^th post-operative day of mitral valve replacement.

Methodology-

A set of Bactec blood culture from a patient grew Enterococcus faecium and Candida tropicalis. The Enterococcus faecium turned out to be Vancomycin resistant on vancomycin Bile aesculin agar (6ug/ml vancomycin) which was confirmed by doing MICs on (PHOENIX B.D) automated identification system.(MIC > 16 �g/ml) and Vancomycin E strip and Broth Microdilution method (MIC > 256 �g/ml). The rectal swab and antecubital swabs for VRE colonization were collected from this patient and 15 patients admitted during this period in the CVTS ICU and CVTS ward along with clinical details. The health care workers were also screened by collecting hand swabs. DNA-DNA hyidization was done to know similarity of index case isolate to that of VRE isolated from gut and skin of other patients.

Results- Out of 9 ICU patients, 4 were colonized with VRE and 5 with Vancomycin Sensitive Enterococci (VSE) in gut. Out of 6 patients in pre-operative ward all were colonized with VRE. DNA hyidization result showed high percentage similarity with index strain in 5 isolates from colonized patients. Prolonged perioperative stay > 2weeks and use of oad spectrum antibiotics like cephalosporins were found to be significant risk factors for VRE Colonization. HCWs were negative for VRE colonization. The outeak was contained by thorough cleaning and fumigation of ICU, preoperative, post operative wards and common utility area like bathroom. All VRE colonized patients were discharged and prescribed probiotics for 3weeks for gut deconatamination.

Conclusion- Vancomycin resistant enterococci are emerging in hospital environment and are responsible for colonization and outeaks of serious hospital acquired infections.