VCU researchers reports success of infection control practices in combating bacteria

By Michael Ford
University News Services

RICHMOND, Va. – Antibiotic resistance is an increasing problem at healthcare facilities, leading to patient infections and increased medical costs. A three-year study indicates that aggressive infection control practices can effectively reduce the spread of an important antibiotic resistant pathogen.

Published in the May 10 issue of The New England Journal of Medicine, the study surveyed 32 health-care facilities in the Midwest. The lead author is Virginia Commonwealth University’s Belinda E. Ostrowsky, M.D., M.P.H., assistant professor of internal medicine and associate epidemiologist at VCU’s Medical College of Virginia Hospitals, who conducted the study during a stint at the Centers for Disease Control and Prevention.

The study was prompted when vancomycin-resistant enterococci (VRE) was detected in December 1996 and began spreading among health-care facilities in the Siouxland Region of Iowa, Nebraska and South Dakota. VRE is an intestine-dwelling bacteria that resists one of medicine’s most effective antibiotics.

The project team collected patient samples in August 1997. Based on the findings of this initial survey, health-care facilities enhanced identification of VRE patients through

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surveillance cultures. Health-care workers received additional education about VRE and, communication between facilities was improved. Facilities also enhanced their infection control precautions such as separating VRE patients from other patients, and encouraging handwashing.

Follow-up prevalence surveys were performed in October 1998 and 1999. An analysis indicated the prevalence of VRE decreased significantly in long-term care facilities, from 2.2 percent to 0.5 percent, and was eliminated in acute-care facilities.

"In an era of emerging antibiotic resistance – when many facilities are abandoning efforts to control transmission, especially of VRE – this program should be viewed as a model for action," Ostrowsky said. "Comprehensive efforts to identify and isolate patients who are colonized with vancomycin-resistant enterococci can reduce the transmission of these strains and even eradicate them."

VRE first emerged in health-care facilities in the United States in 1989. Since then, VRE outbreaks have caused serious patient illness and deaths.

Researchers are focusing on VRE because it carries the genetic building blocks that create resistance to vancomycin, the antibiotic of choice for treating serious infections caused by enterococci, staphylococci and other pathogens. Laboratory studies have shown that enterococci can transfer vancomycin resistance to staphylococci, the most common cause of community and health-care infections.

"What is especially unique about this project is that rather than trying to control VRE in one facility at a time, the entire health-care community worked together to solve the problem," Ostrowsky said. "This partnership of local healthcare facilities, local health departments, state health departments and the federal public health department was a remarkable collaboration that led to the control of VRE transmission."