Vancomycin-resistant enterococcus: emergence to endemicity in a tertiary hospital in Singapore

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2025-08-01 Epub Date: 2025-03-08 DOI:10.1016/j.jhin.2025.02.017

I. Venkatachalam , M.K. Aung , D.C.M. Lai , M.Z.Q. Foo , J.X.Y. Sim , S. Arora , A.M. Oo , Y.T. Fong , K.Y. Tan , L.C. Lee , M.L. Ling

{"title":"Vancomycin-resistant enterococcus: emergence to endemicity in a tertiary hospital in Singapore","authors":"I. Venkatachalam , M.K. Aung , D.C.M. Lai , M.Z.Q. Foo , J.X.Y. Sim , S. Arora , A.M. Oo , Y.T. Fong , K.Y. Tan , L.C. Lee , M.L. Ling","doi":"10.1016/j.jhin.2025.02.017","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>In alignment with national and international recommendations, vancomycin-resistant enterococcus (VRE) surveillance in Singapore General Hospital (SGH) was scaled down and limited to immunocompromised patients from August 2020.</div></div><div><h3>Aim</h3><div>To describe the evolving epidemiology and risk associations of VRE between 2018 and 2023 in a tertiary hospital in Singapore.</div></div><div><h3>Methods</h3><div>Inpatients admitted between January 2018 and December 2023 were included. VRE surveillance criteria changed in August 2020 and November 2022. Incidence of any VRE (VRE (all)), VRE from surveillance (VRE (surveillance)), clinical VRE isolates (VRE (clinical)), healthcare-associated VRE infections (HA-VRE (infections)) and bacteraemia (VRE (bacteraemia)) were reviewed. Three case–control studies were conducted. Environmental screening was performed.</div></div><div><h3>Findings</h3><div>Over the six-year study period there were 5173 patients with VRE, of whom 3141 (60.7%) had HA-VRE, 5157 (99.7%) had <em>E. faecium</em> and 4336 (84%) carried <em>vanA.</em>121 (2.2%) patients had VRE bacteraemia with mortality 50.4%. There were significant changes in incidence of VRE (all), VRE (surveillance) and VRE (clinical) but HA-VRE (infections) and VRE (bacteraemia) remained stable. VRE acquisition was associated with presence of concurrent MRSA (odds ratio: 9.4; 95% confidence interval: 1.3–66.8; <em>P</em> < 0.02), CPE (7.2; 2.0–26.0; <em>P</em> < 0.001), intensive care unit (ICU) admission (6.1; 2.8–13.2; <em>P</em> < 0.001), haemodialysis (4.6; 1.8–12.0; <em>P</em> < 0.001), surgery (3.7; 1.6–8.3; <em>P</em> < 0.001), vancomycin use (28.2; 5.4–146.5; <em>P</em> < 0.001), and metronidazole use (4.4; 1.0–19.0; <em>P</em> = 0.04) in the preceding three months. VRE infection had similar risk associations. In all, 12.5% of environmental samples were VRE positive.</div></div><div><h3>Conclusion</h3><div>VRE endemic state in SGH is associated with significant patient and environmental VRE burden. VRE acquisition and infection have been associated with co-carriage of MRSA or CPE, vancomycin and metronidazole use, ICU admission and prior surgery. Targeted infection prevention and antimicrobial stewardship programmes may reduce VRE (infections).</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"162 ","pages":"Pages 253-262"},"PeriodicalIF":3.1000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hospital Infection","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0195670125000581","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/8 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

In alignment with national and international recommendations, vancomycin-resistant enterococcus (VRE) surveillance in Singapore General Hospital (SGH) was scaled down and limited to immunocompromised patients from August 2020.

Aim

To describe the evolving epidemiology and risk associations of VRE between 2018 and 2023 in a tertiary hospital in Singapore.

Methods

Inpatients admitted between January 2018 and December 2023 were included. VRE surveillance criteria changed in August 2020 and November 2022. Incidence of any VRE (VRE (all)), VRE from surveillance (VRE (surveillance)), clinical VRE isolates (VRE (clinical)), healthcare-associated VRE infections (HA-VRE (infections)) and bacteraemia (VRE (bacteraemia)) were reviewed. Three case–control studies were conducted. Environmental screening was performed.

Findings

Over the six-year study period there were 5173 patients with VRE, of whom 3141 (60.7%) had HA-VRE, 5157 (99.7%) had E. faecium and 4336 (84%) carried vanA.121 (2.2%) patients had VRE bacteraemia with mortality 50.4%. There were significant changes in incidence of VRE (all), VRE (surveillance) and VRE (clinical) but HA-VRE (infections) and VRE (bacteraemia) remained stable. VRE acquisition was associated with presence of concurrent MRSA (odds ratio: 9.4; 95% confidence interval: 1.3–66.8; P < 0.02), CPE (7.2; 2.0–26.0; P < 0.001), intensive care unit (ICU) admission (6.1; 2.8–13.2; P < 0.001), haemodialysis (4.6; 1.8–12.0; P < 0.001), surgery (3.7; 1.6–8.3; P < 0.001), vancomycin use (28.2; 5.4–146.5; P < 0.001), and metronidazole use (4.4; 1.0–19.0; P = 0.04) in the preceding three months. VRE infection had similar risk associations. In all, 12.5% of environmental samples were VRE positive.

Conclusion

VRE endemic state in SGH is associated with significant patient and environmental VRE burden. VRE acquisition and infection have been associated with co-carriage of MRSA or CPE, vancomycin and metronidazole use, ICU admission and prior surgery. Targeted infection prevention and antimicrobial stewardship programmes may reduce VRE (infections).

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

万古霉素耐药肠球菌（VRE）——在新加坡一家三级医院出现地方性流行。

目的：了解新加坡某三级医院2018 - 2023年万古霉素耐药肠球菌（VRE）流行病学演变及风险相关性。方法：纳入2018年1月至2023年12月在新加坡总医院（SGH）住院的患者。VRE监测标准在2020年8月和2022年11月发生了变化。回顾所有VRE（所有VRE）、来自监测的VRE （VRE（监测））、临床VRE分离株（VRE（临床））、医疗相关VRE感染（HA-VRE（感染））和菌血症（VRE（菌血症））的发生率。进行了三项病例对照研究。进行环境筛选。结果：在6年的研究期间，共有5173例VRE患者，其中3141例（60.7%）患有HA-VRE， 5157例（99.7%）患有粪肠杆菌，4336例（84%）携带vanA.121（2.2%）发生VRE菌血症，死亡率50.4%。VRE（全部）、VRE（监测）和VRE（临床）发生率均有显著变化，但HA-VRE（感染）和VRE（菌血症）发生率保持稳定。获得VRE与并发MRSA （OR 9.4, 95% CI 1.3-66.8， p值< 0.02）和CPE （OR 7.2, 95% CI 2.0-26.0， p值）相关。结论：SGH中VRE流行状态与显著的患者和环境VRE负担相关。VRE的获得和感染与MRSA或CPE的共携带、万古霉素和甲硝唑的使用、ICU住院和既往手术有关。有针对性的感染预防和抗菌素管理规划可以减少VRE（感染）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.