Neonatal Intensive Care Unit and Vancomycin-resistant Enterococcus outbreak Interview with:
Elias Iosifidis, MD, PhD
Pediatric Infectious Disease Fellow
Aristotle University of Thessaloniki
Hippokration Hospital
Thessaloniki, Greece What are the main findings of the study?

Dr. Iosifidis: A large outbreak of VRE colonization was found in neonates hospitalized in an intensive care unit (Neonatal Intensive Care Unit, NICU) after the implementation of an active surveillance program. Both high incidence of VRE colonization (or “colonization pressure”) and antibiotic use promoted VRE spread according to the results of the case control study. No proven sources of VRE were found (in local hospital or even in local livestock). A multifaceted management was implemented and included enhanced infection control measures, active surveillance cultures, cohorting of colonized patients, daily audits and optimization of antibiotic therapy. Although the outbreak had a biphasic pattern (monoclonal first wave followed by a polyclonal second wave) strict adherence to the aforementioned bundle of actions was proved essential for reducing VRE colonized cases. During the study period no new VRE infection occurred in neonates. Were any of the findings unexpected?

Dr. Iosifidis: The second wave of this outbreak was unexpected. However, prompt response and adherence to the outbreak’s management actions were crucial for avoiding further spread of VRE among neonates. What should clinicians and patients take away from your report?

Dr. Iosifidis: After the documentation of an infection caused by resistant pathogens, such as VRE, in a NICU, an active surveillance program should be implemented in order to identify burden of VRE colonization in the unit. Prompt management requires a bundle of actions (infection control measures, antibiotic stewardship, case control study, audits, education etc) and adherence on these measures.

Finally even in the case of a large and polyclonal outbreak, control may be achieved with a multifaceted approach. What recommendations do you have for future research as a result of this study?

Dr. Iosifidis: An evidence based approach on the management of outbreaks caused by multidrug resistant bacteria in the setting of neonates is warranted.


Vancomycin-resistant Enterococcus outbreak in a neonatal intensive care unit: Epidemiology, molecular analysis and risk factors.

Third Department of Pediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece.

Last Updated on October 7, 2013 by Marie Benz MD FAAD

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