Resumo

FLORES PAREDES, Wilfredo Hernán. Clinical and epidemiological characteristics of 14 cases of vancomycin-resistant enterococci at the Hospital Nacional Edgardo Rebagliati Martins. Rev Med Hered [online]. 2007, vol.18, n.2, pp.68-75. ISSN 1018-130X.

Objectives: To determine the clinical and epidemiological characteristics of cases with clinical isolation of vancomycin-resistant enterococci (VRE). Material and methods: This is a descriptive and retrospective study. All cases of VRE isolated in the hospital during a 2 year-period from September 2000 to August 2002 was analyzed. Clinical information was taken from patient’s medical chart and from the hospital’s statistical information system. The identification and the susceptibility of isolated strains were carried out using the MicroScan System (Dade Behring). Results: The first isolated of VRE at the hospital was in September 2000. Over a two-year period (Sept-2000 to August-2002) vancomicyn-resistant Enterococcus faecium was isolated in 14 patients from a clinical sample. The positive specimens were blood (7 isolates), urine (6 isolates), central catheter tip (1 isolate) and ascites (1 isolate). The most relevant clinical characteristics of the patients were older age, hemodialysis, complicated abdominal surgery, bed-bound state, and high in-hospital mortality (50%). Intra-hospitalary stay prior isolation was long (mean 41 [1-90] days). Eight (57%) patients were exposed to an ICU and their stay in that unit was also long (mean 34 [8-55] days). Nine (64%) patients received vancomycin. Thirteen (93%) patients were exposed to VRE-related antibiotics (vancomycin, third-generation cephalosporins and antianaerobic drugs). Establishing any epidemiological relationship between the isolates of VRE with the intrahospital follow-up of patients and the microbiologycal phenotype of the isolates, at least two chains of transmission with likely clonal dissemination were found. There was a nosocomial outbreak of VRE in an ICU during December 2001 and January 2002. To date no screening studies on VRE intestinal colonization have been conducted to know the real magnitude of VRE in the hospital. This study proposes the hypothesis that VRE is widely disseminated through the different hospital units, the ICU are being the epicenter of this dissemination; therefore, it is important to abide by the guidelines for preventing the spread of VRE established by the Centers for Disease Control and Prevention (CDC).(Rev Med Hered 2007;18:68-75)

Palavras-chave : Vancomycin-resistant enterococci (VRE),; nosocomial infection; clinical isolation of VRE.

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