C2-2003. Driving Forces of Vancomycin-Resistant E. faecium
Session: Poster Session: Streptocci and Enterococci
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: The use of selected antibiotics (AM) such as vancomycin (VAN), broad-spectrum cephalosporins (BSC) and AM with potent activity against anaerobic bacteria, have been associated with increasing rates of VAN resistant E. faecium (VRE). We evaluated AM use and rates of solid organ (SOT) and bone marrow transplan (BMT), before and after the implementaion of an Antimicrobial Stewardship Program (ASP) and the reemergence of VRE at a tertiary pediatric hospital. Methods: In 2004 active AM surveillance was implemented at AIDHC. Indications for AM use were incorporated as mandatory fields using the computerized information system. A real-time report of AM prescribed, doses, patient demographic and microbiology data was reviewed by a pharmacist and an infectious disease physician. AM use, defined by the number of doses administered / 1000 patient days (DA/1000PD), was measured before and after implementation of ASP. Nosocomial transmission was assessed by PFGE. Data was analyzed with SPSS 14. Results: The use of AM declined from 2088 DA/1000 PD to 1880 DA/1000 PD (P<0.01) while rates of invasive VRE increased from no cases to 6 in 2003-2004 and 2007-2008, respectively. 83% of VRE developed in SOT and BMT patients. Use of VAN declined from 378 DA/1000 PD/year to 252 DA/1000 PD/year (P<0.001). The use of BSC decreased from 475 DA/1000 PD/year to 391 DA/1000 PD/year (P<0.001). The use of metronidazole dropped from 206 DA/1000 PD/year to 61 DA/1000 PD/year (P<0.001). The use of piperacillin-tazobactam (PIPT) decreased over the last two years (P<0.001). Statistical correlation was found between VRE rates and PIPT (r .8, P: 0.01) and BMT (r .5, P:0.05). PFGE identified the same strain in 4/6 patients. Conclusions: In our experience, reemergence of VRE did not correlate with use of VAN, BSC, or other AM except PIPT. BMT and nosocomial transmission were the most important associated factors.
Controlling the forces driving the emergence of invasive VRE infection requires an interdisciplinary approach and commitment
M. Cecilia Di Pentima, MD, MPH, Thomas Jefferson University, Alfred I. duPont Hospital for Children, Wilmington, DE, Shannon Chan, Pharm D, Alfred I. duPont Hospital for Children, Wilmington, DE and  M. Di Pentima, None.

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