PMID- 31312842
OWN - NLM
STAT- Publisher
LR  - 20190717
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
DP  - 2019 Jul 16
TI  - Outbreak of Vancomycin-resistant Enterococcus faecium in Interventional
      Radiology: Detection Through Whole Genome Sequencing-Based Surveillance.
LID - ciz666 [pii]
LID - 10.1093/cid/ciz666 [doi]
AB  - BACKGROUND: Vancomycin-resistant enterococci (VRE) are a major cause of
      hospital-acquired infections. The risk of infection from interventional radiology
      (IR) procedures is not well documented. Whole genome sequencing (WGS)
      surveillance of clinical bacterial isolates among hospitalized patients can
      identify previously-unrecognized outbreaks. METHODS: We analyzed WGS surveillance
      data from November 2016 to November 2017 for evidence of VRE transmission at our 
      hospital. A previously-unrecognized cluster of ten genetically-related VRE
      (Enterococcus faecium) infections was discovered. Electronic health record review
      identified IR procedures as a potential transmission route. An outbreak
      investigation was conducted, which included a matched case-control study.
      RESULTS: Of the ten patient VRE infections, nine had undergone an IR procedure
      with intravenous (IV) contrast </=22 days before infection. In the matched
      case-control study, preceding IR procedure and IR procedure with contrast were
      associated with VRE infection (matched odds ratio 16.72, 95% CI 2.01 to 138.73
      and p=0.009; MOR=39.35, 95% CI 7.85 to infinity, p<0.001, respectively).
      Investigation of IR practices and review of the manufacturer's training video
      revealed sterility breaches in contrast preparation. Our investigation also
      supported possible transmission from an IR technician. Infection prevention
      interventions were implemented and no further IR-associated VRE transmissions
      have been observed. CONCLUSIONS: A prolonged outbreak of VRE infections related
      to IR procedures with IV contrast resulted from non-sterile preparation of
      injectable contrast. The fact that our VRE outbreak was discovered through WGS
      surveillance and the manufacturer's training video demonstrating non-sterile
      technique raise the possibility that infections following invasive IR procedures 
      may be more common than previously recognized.
CI  - (c) The Author(s) 2019. Published by Oxford University Press for the Infectious
      Diseases Society of America. All rights reserved. For permissions, e-mail:
      journals.permissions@oup.com.
FAU - Sundermann, Alexander J
AU  - Sundermann AJ
AD  - Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of
      Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
AD  - Department of Infection Control and Hospital Epidemiology, University of
      Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
FAU - Babiker, Ahmed
AU  - Babiker A
AD  - Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of
      Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
AD  - Division of Infectious Diseases, University of Pittsburgh School of Medicine,
      Pittsburgh, Pennsylvania, USA.
FAU - Marsh, Jane W
AU  - Marsh JW
AD  - Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of
      Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
AD  - Division of Infectious Diseases, University of Pittsburgh School of Medicine,
      Pittsburgh, Pennsylvania, USA.
FAU - Shutt, Kathleen A
AU  - Shutt KA
AD  - Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of
      Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
AD  - Division of Infectious Diseases, University of Pittsburgh School of Medicine,
      Pittsburgh, Pennsylvania, USA.
FAU - Mustapha, Mustapha M
AU  - Mustapha MM
AD  - Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of
      Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
AD  - Division of Infectious Diseases, University of Pittsburgh School of Medicine,
      Pittsburgh, Pennsylvania, USA.
FAU - Pasculle, Anthony W
AU  - Pasculle AW
AD  - Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
FAU - Ezeonwuka, Chinelo
AU  - Ezeonwuka C
AD  - Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of
      Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
AD  - Division of Infectious Diseases, University of Pittsburgh School of Medicine,
      Pittsburgh, Pennsylvania, USA.
FAU - Saul, Melissa I
AU  - Saul MI
AD  - Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of
      Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
FAU - Pacey, Marissa P
AU  - Pacey MP
AD  - Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of
      Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
AD  - Division of Infectious Diseases, University of Pittsburgh School of Medicine,
      Pittsburgh, Pennsylvania, USA.
FAU - Van Tyne, Daria
AU  - Van Tyne D
AD  - Division of Infectious Diseases, University of Pittsburgh School of Medicine,
      Pittsburgh, Pennsylvania, USA.
FAU - Ayres, Ashley M
AU  - Ayres AM
AD  - Department of Infection Control and Hospital Epidemiology, University of
      Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
FAU - Cooper, Vaughn S
AU  - Cooper VS
AD  - Department of Microbiology and Molecular Genetics, University of Pittsburgh
      School of Medicine, Pittsburgh, Pennsylvania, USA.
FAU - Snyder, Graham M
AU  - Snyder GM
AD  - Department of Infection Control and Hospital Epidemiology, University of
      Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
AD  - Division of Infectious Diseases, University of Pittsburgh School of Medicine,
      Pittsburgh, Pennsylvania, USA.
FAU - Harrison, Lee H
AU  - Harrison LH
AD  - Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of
      Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
AD  - Division of Infectious Diseases, University of Pittsburgh School of Medicine,
      Pittsburgh, Pennsylvania, USA.
LA  - eng
PT  - Journal Article
DEP - 20190716
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases
      Society of America
JID - 9203213
OTO - NOTNLM
OT  - Enterococcus faecium
OT  - Outbreak detection
OT  - healthcare-associated infections
OT  - interventional radiology
OT  - vancomycin-resistant Enterococcus
OT  - whole genome sequencing
EDAT- 2019/07/18 06:00
MHDA- 2019/07/18 06:00
CRDT- 2019/07/18 06:00
PHST- 2019/04/23 00:00 [received]
PHST- 2019/07/18 06:00 [entrez]
PHST- 2019/07/18 06:00 [pubmed]
PHST- 2019/07/18 06:00 [medline]
AID - 5532797 [pii]
AID - 10.1093/cid/ciz666 [doi]
PST - aheadofprint
SO  - Clin Infect Dis. 2019 Jul 16. pii: 5532797. doi: 10.1093/cid/ciz666.