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Article: Extensive contact tracing and screening to control the spread of vancomycin-resistant enterococcus faecium ST414 in Hong Kong

TitleExtensive contact tracing and screening to control the spread of vancomycin-resistant enterococcus faecium ST414 in Hong Kong
Authors
Issue Date2012
PublisherChinese Medical Association. The Journal's web site is located at http://www.cmj.org/
Citation
Chinese Medical Journal, 2012, v. 125 n. 19, p. 3450-3457 How to Cite?
AbstractBackground Proactive infection control management is crucial in preventing the introduction of multiple drug resistant organisms in the healthcare setting. In Hong Kong, where vancomycin-resistant enterococci (VRE) endemicity is not yet established, contact tracing and screening, together with other infection control measures are essential in limiting intraand inter-hospital transmission. The objective of this study was to illustrate the control measures used to eradicate a VRE outbreak in a hospital network in Hong Kong. Methods We described an outbreak of VRE in a healthcare region in Hong Kong, involving a University affiliated hospital and a convalescent hospital of 1600 and 550 beds respectively. Computer-assisted analysis was utilized to facilitate contact tracing, followed by VRE screening using chromogenic agar. Multi-locus sequence typing (MLST) was performed to assess the clonality of the VRE strains isolated. A case-control study was conducted to identify the risk factors for nosocomial acquisition of VRE. Results Between November 26 and December 17, 2011, 11 patients (1 exogenous case and 10 secondary cases) in two hospitals with VRE colonization were detected during our outbreak investigation and screening for 361 contact patients, resulting in a clinical attack rate of 2.8% (10/361). There were 8 males and 3 females with a median age of 78 years (range, 40-87 years). MLST confirmed sequence type ST414 in all isolates. Case-control analysis demonstrated that VRE positive cases had a significantly longer cumulative length of stay (P <0.001), a higher proportion with chronic cerebral and cardiopulmonary conditions (P=0.001), underlying malignancies (P <0.001), and presence of urinary catheter (P <0.001), wound or ulcer (P <0.001), and a greater proportion of these patients were receiving β-lactam/β-lactamase inhibitors (P=0.009), carbapenem group (P <0.001), fluoroquinolones (P=0.003), or vancomycin (P=0.001) when compared with the controls. Conclusion Extensive contact tracing and screening with a "search-and-confine" strategy was a successful tool for outbreak control in our healthcare region.
Persistent Identifierhttp://hdl.handle.net/10722/182356
ISSN
2015 Impact Factor: 0.957
2015 SCImago Journal Rankings: 0.428
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheng, VCCen_US
dc.contributor.authorTai, JWMen_US
dc.contributor.authorNg, MLMen_US
dc.contributor.authorChan, JFWen_US
dc.contributor.authorWong, SCYen_US
dc.contributor.authorLi, IWSen_US
dc.contributor.authorChung, HOen_US
dc.contributor.authorLo, WKen_US
dc.contributor.authorYuen, KYen_US
dc.contributor.authorHo, Plen_US
dc.date.accessioned2013-04-23T08:20:02Z-
dc.date.available2013-04-23T08:20:02Z-
dc.date.issued2012en_US
dc.identifier.citationChinese Medical Journal, 2012, v. 125 n. 19, p. 3450-3457en_US
dc.identifier.issn0366-6999en_US
dc.identifier.urihttp://hdl.handle.net/10722/182356-
dc.description.abstractBackground Proactive infection control management is crucial in preventing the introduction of multiple drug resistant organisms in the healthcare setting. In Hong Kong, where vancomycin-resistant enterococci (VRE) endemicity is not yet established, contact tracing and screening, together with other infection control measures are essential in limiting intraand inter-hospital transmission. The objective of this study was to illustrate the control measures used to eradicate a VRE outbreak in a hospital network in Hong Kong. Methods We described an outbreak of VRE in a healthcare region in Hong Kong, involving a University affiliated hospital and a convalescent hospital of 1600 and 550 beds respectively. Computer-assisted analysis was utilized to facilitate contact tracing, followed by VRE screening using chromogenic agar. Multi-locus sequence typing (MLST) was performed to assess the clonality of the VRE strains isolated. A case-control study was conducted to identify the risk factors for nosocomial acquisition of VRE. Results Between November 26 and December 17, 2011, 11 patients (1 exogenous case and 10 secondary cases) in two hospitals with VRE colonization were detected during our outbreak investigation and screening for 361 contact patients, resulting in a clinical attack rate of 2.8% (10/361). There were 8 males and 3 females with a median age of 78 years (range, 40-87 years). MLST confirmed sequence type ST414 in all isolates. Case-control analysis demonstrated that VRE positive cases had a significantly longer cumulative length of stay (P <0.001), a higher proportion with chronic cerebral and cardiopulmonary conditions (P=0.001), underlying malignancies (P <0.001), and presence of urinary catheter (P <0.001), wound or ulcer (P <0.001), and a greater proportion of these patients were receiving β-lactam/β-lactamase inhibitors (P=0.009), carbapenem group (P <0.001), fluoroquinolones (P=0.003), or vancomycin (P=0.001) when compared with the controls. Conclusion Extensive contact tracing and screening with a "search-and-confine" strategy was a successful tool for outbreak control in our healthcare region.en_US
dc.languageengen_US
dc.publisherChinese Medical Association. The Journal's web site is located at http://www.cmj.org/en_US
dc.relation.ispartofChinese Medical Journalen_US
dc.subject.meshAgeden_US
dc.subject.meshAged, 80 And Overen_US
dc.subject.meshEnterococcus Faecium - Growth & Development - Pathogenicityen_US
dc.subject.meshFemaleen_US
dc.subject.meshGram-Positive Bacterial Infections - Epidemiology - Prevention & Controlen_US
dc.subject.meshHong Kong - Epidemiologyen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshVancomycin Resistanceen_US
dc.titleExtensive contact tracing and screening to control the spread of vancomycin-resistant enterococcus faecium ST414 in Hong Kongen_US
dc.typeArticleen_US
dc.identifier.emailChan, JFw: jfwchan@hku.hken_US
dc.identifier.emailYuen, Ky: kyyuen@hkucc.hku.hken_US
dc.identifier.emailHo, Pl: plho@hkucc.hku.hken_US
dc.identifier.authorityChan, JFw=rp01736en_US
dc.identifier.authorityYuen, Ky=rp00366en_US
dc.identifier.authorityHo, Pl=rp00406en_US
dc.description.naturelink_to_OA_fulltexten_US
dc.identifier.doi10.3760/cma.j.issn.0366-6999.2012.19.017en_US
dc.identifier.pmid23044305-
dc.identifier.scopuseid_2-s2.0-84867414314en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-84867414314&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume125en_US
dc.identifier.issue19en_US
dc.identifier.spage3450en_US
dc.identifier.epage3457en_US
dc.identifier.isiWOS:000311265000017-
dc.publisher.placeChinaen_US
dc.identifier.scopusauthoridCheng, VCc=55259805600en_US
dc.identifier.scopusauthoridTai, JWm=7101993154en_US
dc.identifier.scopusauthoridNg, MLm=55388370100en_US
dc.identifier.scopusauthoridChan, JFw=24278817900en_US
dc.identifier.scopusauthoridWong, SCy=55388445000en_US
dc.identifier.scopusauthoridLi, IWs=24464179500en_US
dc.identifier.scopusauthoridChung, Hp=55388189200en_US
dc.identifier.scopusauthoridLo, Wk=7201502414en_US
dc.identifier.scopusauthoridYuen, Ky=36078079100en_US
dc.identifier.scopusauthoridHo, Pl=7402211363en_US

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