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AIM/BACKGROUND: Infection control measures are disrupted due to the large number of patients admitted in a very short time, in the early post-earthquake period. Inter-hospital or intra-hospital transfers can cause the spread of resistant bacteria (1). We reported the possible outbreak and its prevention caused by vancomycin-resistant enterococcus (VRE) strains carried by infants transferred from another unit to Kayseri City Hospital NICU after the earthquake in Turkey. METHODS: Screening cultures (rectal swab) were obtained from infants on admission and patients were kept in cantact isolation. VRE isolated from 13 transferred patients, 3 current patients and 2 environmental samples were confirmed by MALDI-TOF MS (BRUKER, Microflex) and analyzed using Pulsed-Field Gel Electrophoresis (PFGE) Method and CHEF-DR III system (Bio-RadLaboratories, Belgium). RESULTS: PFGE identified 18 isolates in 8 groups. Isolates 2, 4, 5, 6, 7, 13 and 18 in the 8th group were clonally related. Isolates 9, 11 and 17 in the 3rd group and isolates 12, 14 and 16 in the 1st group are clonally related. Isolates 1, 3, 8, 10 and 15 were not associated with any sample and were considered as unique. Isolates 9, 11 and 17 in one of the other two groups and isolates 12, 14 and 16 in the last group were clonally related (Figure 1). Rectal swab culture for screening and contact isolation on admission, prevented a possible VRE outbreak. CONCLUSIONS: After major disasters, it is important to comply with infection control measures as much as possible to prevent outbreaks and secondary damage.

Abstract Background Vancomycin-resistant enterococcus (VRE) was the fastest growing pathogen in Europe in 2022 (+ 21%) but its clinical relevance is still unclear. We aim to identify risk factors for acquired VRE rectal colonization in hematological patients and evaluate the clinical impact of VRE colonization on subsequent infection, and 30- and 90-day overall mortality rates, compared to a matched control group. Methods A retrospective, single center, case–control matched study (ratio 1:1) was conducted in a hematological department from January 2017 to December 2020. Case patients with nosocomial isolation of VRE from rectal swab screening (≥ 48 h) were matched to controls by age, sex, ethnicity, and hematologic disease. Univariate and multivariate logistic regression compared risk factors for colonization. Results A total of 83 cases were matched with 83 controls. Risk factors for VRE colonization were febrile neutropenia, bone marrow transplant, central venous catheter, bedsores, reduced mobility, altered bowel habits, cachexia, previous hospitalization and antibiotic treatments before and during hospitalization. VRE bacteraemia and Clostridioides difficile infection (CDI) occurred more frequently among cases without any impact on 30 and 90-days overall mortality. Vancomycin administration and altered bowel habits were the only independent risk factors for VRE colonization at multivariate analysis (OR: 3.53 and 3.1; respectively). Conclusions Antimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for VRE nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between CDI and VRE, which deserves further investigation to target new therapeutic approaches.

Antimicrobial resistance (AMR) in bacterial pathogens has emerged as a challenge in health care settings resulting in high rates of morbidity and mortality. The aim of the present study was to describe the trends and burden of AMR in a tertiary care hospital. A retrospective observational study was undertaken from October 2018 to March 2021 in a clinical microbiology laboratory where local priority pathogens and their antimicrobial resistance patterns were analyzed. Organism identification and antimicrobial susceptibility testing were performed as per Clinical and Laboratory Standards Institute guidelines. Out of 9948 isolates, Enterobacteriaceae (58%) were mostly isolated followed by Staphylococci (18.6%), Non-fermenting gram negative bacilli (NFGNB) (13.7%), and Enterococci (8.4%) respectively. Highest isolation was from inpatient department (61.3%); 31.5% from outpatient, and 7.2 % from intensive care units. Klebsiella pneumoniae (26.9%) was most isolated organism, mostly from respiratory samples; Escherichia coli was isolated mostly from urine (40.7%). Almost half of the Enterobacteriaceae isolates were extended spectrum beta-lactamase producers while >50% of Enterobacteriaceae and NFGNB isolates were resistant to one or more Carbapenems. Frequency of Methicillin resistant Staphylococcus aureus was 44.7% , Vancomycin resistant Enterococci was 1.2%. A rising trend of resistance to cephalosporins and carbapenems along with fluoroquinolones was observed. Our study has witnessed a high prevalence of Gram negative pathogens with increasing resistance to commonly applied antimicrobials during the surveillance period which can act as a guiding tool in devising local antimicrobial priorities, antibiotic policy, and proper antimicrobial prescribing practices.

Background: Vancomycin-resistant enterococcus (VRE) was the fastest growing pathogen in Europe in 2022 (+ 21%) but its clinical relevance is still unclear. We aim to identify risk factors for acquired VRE rectal colonization in hematological patients and evaluate the clinical impact of VRE colonization on subsequent infection, and 30- and 90-day overall mortality rates, compared to a matched control group. Methods: A retrospective, single center, case–control matched study (ratio 1:1) was conducted in a hematological department from January 2017 to December 2020. Case patients with nosocomial isolation of VRE from rectal swab screening (≥ 48 h) were matched to controls by age, sex, ethnicity, and hematologic disease. Univariate and multivariate logistic regression compared risk factors for colonization. Results: A total of 83 cases were matched with 83 controls. Risk factors for VRE colonization were febrile neutropenia, bone marrow transplant, central venous catheter, bedsores, reduced mobility, altered bowel habits, cachexia, previous hospitalization and antibiotic treatments before and during hospitalization. VRE bacteraemia and Clostridioides difficile infection (CDI) occurred more frequently among cases without any impact on 30 and 90-days overall mortality. Vancomycin administration and altered bowel habits were the only independent risk factors for VRE colonization at multivariate analysis (OR: 3.53 and 3.1; respectively). Conclusions: Antimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for VRE nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between CDI and VRE, which deserves further investigation to target new therapeutic approaches. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) in bacterial pathogens has emerged as a challenge in health care settings resulting in high rates of morbidity and mortality. The aim of the present study was to describe the trends and burden of AMR in a tertiary care hospital. A retrospective observational study was undertaken from October 2018 to March 2021 in a clinical microbiology laboratory where local priority pathogens and their antimicrobial resistance patterns were analyzed. Organism identification and antimicrobial susceptibility testing were performed as per Clinical and Laboratory Standards Institute guidelines. Out of 9948 isolates, Enterobacteriaceae (58%) were mostly isolated followed by Staphylococci (18.6%), Non-fermenting gram negative bacilli (NFGNB) (13.7%), and Enterococci (8.4%) respectively. Highest isolation was from inpatient department (61.3%); 31.5% from outpatient, and 7.2 % from intensive care units. Klebsiella pneumoniae (26.9%) was most isolated organism, mostly from respiratory samples; Escherichia coli was isolated mostly from urine (40.7%). Almost half of the Enterobacteriaceae isolates were extended spectrum beta-lactamase producers while >50% of Enterobacteriaceae and NFGNB isolates were resistant to one or more Carbapenems. Frequency of Methicillin resistant Staphylococcus aureus was 44.7%, Vancomycin resistant Enterococci was 1.2%. A rising trend of resistance to cephalosporins and carbapenems along with fluoroquinolones was observed. Our study has witnessed a high prevalence of Gram negative pathogens with increasing resistance to commonly applied antimicrobials during the surveillance period which can act as a guiding tool in devising local antimicrobial priorities, antibiotic policy, and proper antimicrobial prescribing practices. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTIs) are among the most common causes of infections worldwide and can be caused by numerous uropathogens. Enterococci are Gram-positive, facultative anaerobic commensal organisms of the gastrointestinal tract that are known uropathogens. Enterococcus spp. has become a leading cause of healthcare associated infections, ranging from endocarditis to UTIs. In recent years, there has been an increase in multidrug resistance due to antibiotic misuse, especially in enterococci. Additionally, infections due to enterococci pose a unique challenge due to their ability to survive in extreme environments, intrinsic antimicrobial resistance, and genomic malleability. Overall, this review aims to highlight the pathogenicity, epidemiology, and treatment recommendations (according to the most recent guidelines) of enterococci. [ABSTRACT FROM AUTHOR]

ABSTRACT A high daptomycin dose has been suggested for treating vancomycin-resistant Enterococcus faecium (VREf) infections. However, even a 12 mg/kg daptomycin dose might be insufficient for treating VREf with high daptomycin minimum inhibitory concentrations (MICs). Additionally, animal pharmacodynamic and infection models to confirm the efficacy of 12 mg/kg daptomycin are lacking. Male Wistar rats were used for pharmacokinetic profiling and for the development of an infective endocarditis (IE) model. Daptomycin-susceptible dose-dependent VREf (DSE) (MIC of 0.5 mg/L) and daptomycin nonsusceptible VREf (DNSE) (MIC of 8 mg/L) were used for the IE models. The bacterial load of vegetation was the primary outcome and was evaluated after 3 days of daptomycin treatment. Daptomycin administered subcutaneously (s.c.) at 45 and 90 mg/kg, which corresponded to maximum serum concentrations (Cmax) of 122.6 mg/L and 178.5 mg/L, respectively, was equivalent to doses of 8 mg/kg and 12 mg/kg, respectively, in humans. The Cmax/MIC value was correlated with the bacterial load of vegetation after treatment (r = −0.88, P < 0.001). The 90 mg/kg s.c. group showed a significantly lower bacterial load of vegetation (log10 CFU/g) than the 45 mg/kg s.c. group against DSE (0 versus 4.75, P < 0.001) and DNSE (5.12 versus 6.98, P = 0.002). The 90 mg/kg s.c. group did not sterilize the vegetation against DNSE. Although the human equivalent dose of 12 mg/kg daptomycin was more effective than the smaller dose in reducing the bacterial load in DSE and DNSE IE, the dose could not sterilize the vegetation during a DNSE treatment. Further treatment strategies by which to manage severe VREf infections, especially at high daptomycin MICs, are urgently needed. IMPORTANCE Using a rat IE model with pharmacokinetic analysis, the treatment response of VREf IE was found to be daptomycin dose-dependent, presented as Cmax/MIC or as the 24 h area under the concentration-time curve (AUC0–24)/MIC. Daptomycin 90 mg/kg s.c. significantly reduced the bacterial load against DSE and DNSE. It also showed significant activity against DSE and DNSE, compared to 45 mg/kg s.c. Although daptomycin 90 mg/kg can eradicate the bacterial load after 3 days of treatment against DSE, eradication cannot be achieved with 90 mg/kg daptomycin against DNSE.

Introduction: Tigecycline is a potential therapeutic agent for multidrug resistant gram positive and gram negative organisms. The clinical efficacy of synergic combination of daptomycin with betalactam antibiotics have been described against various species of Enterococcus isolates. Aim: To detect the in-vitro activity of tigecycline and daptomycin against Enterococcus species and to compare their antimicrobial activity by Vitek 2 automated system. Materials and Methods: This was a cross-sectional study conducted at Department of Microbiology, Vinayaka Mission’s Kirupananda Variyar (VMKV) Medical College and Hospitals, Salem, Tamil Nadu, India. Isolates of Enterococcus obtained over a period of two years from March 2016 - March 2018 from various clinical samples were identified by standard biochemical method and their antimicrobial susceptibility pattern was determined. Minimum Inhibitory Concentration (MIC) of tigecycline and daptomycin was determined by Vitek 2 automated system. Analysis of data was done by using frequency distribution and percentage. Results: Out of 211 Enterococcus isolates studied, 23 (10.90%) isolates showed decreased susceptibility to daptomycin with MIC of ≥8 μg/mL. All isolates showed 100% susceptibility to tigecycline. Conclusion: The present study showed potent antimicrobial activity of tigecycline against various species of Enterococcus. Decreased susceptibility to daptomycin has been observed among the study isolates. Further clinical investigations are required to know the potential benefits of these agents in therapy.

Urinary tract infections (UTIs) are among the most common causes of infections worldwide and can be caused by numerous uropathogens. Enterococci are Gram-positive, facultative anaerobic commensal organisms of the gastrointestinal tract that are known uropathogens. Enterococcus spp. has become a leading cause of healthcare associated infections, ranging from endocarditis to UTIs. In recent years, there has been an increase in multidrug resistance due to antibiotic misuse, especially in enterococci. Additionally, infections due to enterococci pose a unique challenge due to their ability to survive in extreme environments, intrinsic antimicrobial resistance, and genomic malleability. Overall, this review aims to highlight the pathogenicity, epidemiology, and treatment recommendations (according to the most recent guidelines) of enterococci.

Aims: The objective of this study was to isolate multifunctional bacteriocin‐producing strains; to characterize the expressed bacteriocin for the control of Listeria monocytogenes and vancomycin‐resistant Enterococcus; to evaluate the safety of studied strains; and to explore their antifungal activity. Methods and Results: Two Pediococcus strains were isolated from silage samples obtained from an organic farm in Belogradchik, Bulgaria. The strains were identified by 16S rRNA sequencing analysis and characterized as bacteriocins producers. Strong antimicrobial activity was detected against more than 74 different strains of Listeria monocytogenes, 27 different vancomycin‐resistant Enterococcus strains. In addition, studied strains were able to inhibit the growth of strains of Alternaria alternate, Aspergillus flavus, Aspergillus niger, Cladosporium sphaerospermum, Penicillium chrysogenum and Penicillium expansum. Some aspects of the antimicrobial mode of action were evaluated, including killing curves and aggregation properties. Both strains generated positive PCR results for the presence of pediocin PA‐1, but not for other bacteriocins evaluated in this screening process. Metabolomic analysis of the cell‐free supernatants from both strains was performed in order to explain the observed antifungal activity against different moulds. According to PCA and PLS‐DA score plot, P. acidilactici ST3522BG and P. pentosaceus ST3633BG were clearly clustered from control (MRS). Increases in the production of benzoic acid, 2‐hydroxyisocaproic acid, β‐phenyl‐lactic acid, α‐hydroxybutyric acid and 1,3‐butanediol were recorded, these metabolites were previously described as antifungal. Conclusions: Pediococcus acidilactici ST3522BG and P. pentosaceus ST3633BG were evaluated as producing bacteriocin strains with high specificity against Listeria and vancomycin‐resistant Enterococcus species. In addition, both investigated Pediococcus strains were evaluated as producer of effective antifungal metabolites with potential for the inhibition of mycotoxin‐producing moulds. Significance and Impact of the Study: To the best of our knowledge, this report is a pioneer in the evaluation of Pediococcus strains isolated from silage with highly specific bacteriocinogenic antimicrobial activity against Listeria spp. and vancomycin‐resistant Enterococcus spp., and antifungal activity against mycotoxin‐producing moulds. [ABSTRACT FROM AUTHOR]

Introduction: Tigecycline is a potential therapeutic agent for multidrug resistant gram positive and gram negative organisms. The clinical efficacy of synergic combination of daptomycin with betalactam antibiotics have been described against various species of Enterococcus isolates. Aim: To detect the in-vitro activity of tigecycline and daptomycin against Enterococcus species and to compare their antimicrobial activity by Vitek 2 automated system. Materials and Methods: This was a cross-sectional study conducted at Department of Microbiology, Vinayaka Mission's Kirupananda Variyar (VMKV) Medical College and Hospitals, Salem, Tamil Nadu, India. Isolates of Enterococcus obtained over a period of two years from March 2016 - March 2018 from various clinical samples were identified by standard biochemical method and their antimicrobial susceptibility pattern was determined. Minimum Inhibitory Concentration (MIC) of tigecycline and daptomycin was determined by Vitek 2 automated system. Analysis of data was done by using frequency distribution and percentage. Results: Out of 211 Enterococcus isolates studied, 23 (10.90%) isolates showed decreased susceptibility to daptomycin with MIC of =8 µg/mL. All isolates showed 100% susceptibility to tigecycline. Conclusion: The present study showed potent antimicrobial activity of tigecycline against various species of Enterococcus. Decreased susceptibility to daptomycin has been observed among the study isolates. Further clinical investigations are required to know the potential benefits of these agents in therapy. [ABSTRACT FROM AUTHOR]

In Ontario, Canada, since 2012, some hospitals discontinued contact precautions for vancomycin-resistant Enterococcus (VRE). Between 2009 and 2018, there was an associated rise in VRE bloodstream infections in hospitals where contact precautions were discontinued but not in hospitals that maintained contact precautions. These data suggest contact precautions are important for hospital VRE control programs. [ABSTRACT FROM AUTHOR]

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Aim: Enterococci are located in the intestinal flora of animals and humans and have become a major cause of healthcare-associated infections over the years. In this study, related factors were investigated for the isolation of vancomycin-resistant enterococci (VRE) from rectal swab specimens of patients admitted to the internal medicine service. Material and Methods: TRectal swab samples were obtained from 316 patients. VITEK-2 (bioMérieux, Marcy l’Etoile, France) automated system was used for identification of enterococci. Vancomycin susceptibility was studied by Kirby-Bauer disc diffusion method. Resistant strains were confirmed by vancomycin E-test (bioMerieux). Results: VRE was growth in 70 (22.2%) of 316 patients included in the study. According to the univariate analysis results which comparing patients who were colonized with VRE to the control group; These were found, the duration of hospitalization for VRE colonized patients was significantly longer, the usage of glycopeptide and metronidazole increased the VRE colonization and VRE colonized patients were found to have more parenteral feeding. It was determined that hemoglobin, thyroxine and albumin values of patients colonized with VRE were lower. According to the logistic regression analysis, patients with VRE colonization had a higher rate of history in the intensive care unit and higher gamma glutamyl transferase value. Conclusion: It was determined that the hospitalization history in intensive care unit is a risk factor for VRE colonization and especially in patients transported from intensive care unit. Patients colonized with VRE have been found to have higher GGT values and new research on this topic is considered to be needed. [ABSTRACT FROM AUTHOR]

Vancomycin-resistant enterococcus (VRE) is now one of the leading causes of nosocomial infections in the United States. Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of VRE colonization and infection. VRE has emerged as a major cause of bacteremia in this population, raising important clinical questions regarding the role and impact of VRE colonization and infection in HSCT outcomes as well as the optimal means of prevention and treatment. We review here the published literature and scientific advances addressing these thorny issues and provide a rational framework for their approach.

Objective: To investigate the epidemiological characteristics and risk factors of vancomycin resistant enterococcus (VRE) infection in intensive care unit (ICU) of department of neurosurgery, and to provide reference for clinical prevention and control. Methods: A total of 420 patients, who underwent surgery in the ICU of department of neurosurgery in Taizhou Hospital of Traditional Chinese Medicine from January 2014 to January 2016, were chosen as subjects. The application of antibiotics before infection in the pa­tients with VRE infection was compared, and univariate and multivariate Logistic regression analysis were used to analyze the risk factors of VRE infection to propose the prevention and control measures. Results: Among the 420 inpatients in ICU, there were 58 cases of VRE infection, accounted for 13.81%. The most common antibiotics used before VRE infection was three generation cephalosporin, accounted for 37.93%, and four generation cephalosporin was least, accounted for 6.90%. Single factor and Logistic regression analysis showed that the ICU hospitalization times⩾ 14 d, indwelling catheters⩾ 14 d, Glasgow Coma Scale (GCS) score<8 and patients infected by VRE near­by were the risk factors of VRE infection(P<0.05). Conclusion: The most common antibiotics used before VRE infection is three genera­tion cephalosporin. ICU hospitalization times⩾ 14 d, indwelling catheters⩾ 14 d, GCS score<8 and patients infected by VRE nearby are the risk factors of VRE infection. Rational use of antibiotics and taking corresponding prevention and control measures are necessary in the clinical practice to reduce the incidence of VRE infection. [ABSTRACT FROM AUTHOR]

Daptomycin is typically the treatment of choice for vancomycin resistant Enterococcus (VRE) bloodstream infections (BSI) in patients with hematological malignancies, but increasingly daptomycin nonsusceptible VRE are being reported. We reviewed our experience with daptomycin nonsusceptible VRE BSI among patients with hematological malignancies. We compared risk factors and outcomes of 20 patients with daptomycin nonsusceptible VRE BSI (case patients) with 40 matched control patients with daptomycin susceptible VRE BSI. Case patients had more complications (6/20 vs. 2/40, p=.013); all-cause mortality was similar in both groups. By multivariable analysis, only prior daptomycin exposure within 90 days was significantly associated with daptomycin nonsusceptible VRE BSI (odds ratio 26.71; p<.0001). In 25% of case patients, all of whose VRE isolates had an initial minimum inhibitory concentration (MIC) of 4 μg/mL, nonsusceptibility developed during treatment, raising the question of whether higher doses of daptomycin should be used for VRE BSI in hematology patients. [ABSTRACT FROM AUTHOR]

In this study, specific binding affinity between vancomycin (VAN) conjugated 40-50 nm gold nanoparticles (Au NPs) implemented on a sensor chip and pentapeptide mimicking pathogenic VAN resistant Enterococcus (VRE) wall membrane was employed as nanosensor format based on localized surface plasmon resonance (LSPR). Two pentapeptides, which were also anchored to 5 nm Au NPs, having two different terminal sequences of d-Ala- d-Ala and d-Ala- d-Lac respectively were compared in specific binding affinity toward the VAN conjugated nanosensor. Binding affinity difference identified by the LSPR characteristic in the nanosensor was shown in absorbance intensity and absorption wavelength shift between the two different terminal pentapeptides. The absorbance intensity clearly indicated that the pentapeptide having terminal d-Ala- d-Lac showed less affinity toward VAN conjugated nanosensor chip than that having terminal d-Ala- d-Ala. It indicates that the VRE itself has relatively weak binding strength towards the VAN, which may be used as a probe molecule for the VRE. Therefore, in order to design a VRE sensor using the VAN affinity, an indirect LSPR method can be devised instead of direct LSPR method. [ABSTRACT FROM AUTHOR]

Purpose: To highlight good visual outcome with intravitreal amikacin administered 18 days following trauma-inducing vancomycin resistant enterococcal endophthalmitis treated initially with vitrectomy and oral linezolid. Observations: Despite initial vitrectomy, intravitreal vancomycin, ceftazidime and oral linezolid, smoldering vitreous infiltrates prompted treatment with intravitreal amikacin 18 days later and restored vision to 20/40 in a vancomycin-resistant traumatic endophthalmitis. Conclusions and importance: Good visual outcome was attained with intravitreal injection of amikacin 18 days following penetrating trauma and vancomycin resistant enterococcal endophthalmitis that smoldered following initial treatment of vitrectomy, intravitreal antibiotics and oral linezolid.

Purpose: Hospital-acquired infections are increasing in frequency due to multidrug resistant organisms (MDROs), and the spread of MDROs has eroded our ability to treat infections. Health care professionals cannot rely solely on traditional infection control measures and antimicrobial stewardship to prevent MDRO transmission. We review research on the microbiota as a target for infection control interventions.Methods: We performed a literature review of key research findings related to the microbiota as a target for infection control interventions. These data are summarized and used to outline challenges, opportunities, and unanswered questions in the field.Results: The healthy microbiota provides protective functions including colonization resistance, which refers to the microbiota's ability to prevent colonization and/or expansion of pathogens. Antibiotic use and other exposures in hospitalized patients are associated with disruptions of the microbiota that may reduce colonization resistance and select for antibiotic resistance. Novel methods to exploit protective mechanisms provided by an intact microbiota may provide the key to preventing the spread of MDROs in the health care setting.Conclusions: Research on the microbiota as a target for infection control has been limited. Epidemiologic studies will facilitate progress toward the goal of manipulating the microbiota for control of MDROs in the health care setting. [ABSTRACT FROM AUTHOR]

Objective: Enterococci exist in normal gastrointestinal flora. Formerly they used to have low potential of formation of infection, since 1970s due to the usage of cephalosporins which they have a natural resistance; they have an important place among the factors of nosocomial infection. The aim of this study was to evaluate the status of VRE colonization in Duzce University Research and Training Hospital, Turkey, following a VRE isolation from the blood sample of a patient (index case). Methods: This study carried out between December 2011 – April 2013 in Düzce University Research and Training Hospital intensive care and dialysis departments which are considered as high risk of nosocomial infection. This study carried out in 2 steps. As a first step once a week and as a second step monthly rectal swaps and environmental samples were collected from all patients of intensive care unit. Results: The rate of VRE colonization was determined in 27 rectal swap sample (6%), 29 environmental culture sample (4%). As a precaution, the hospital was close contact insulation program. As a results of measures taken, in second step there are no vancomycin-resistant enterococcus detected. With acquisitions of these precautions the rate of vancomycin-resistant enterococcus was decreased rapidly. Conclusion: For the prevention of colonization with VRE in hospitals; the performance of periodic surveillance studies, starting with the strict contact isolation programs, in-service training of staff on hand washing, is thought to the importance of ensuring the enforcement of restricted use of antibiotics policy and sustainability. [ABSTRACT FROM AUTHOR]

Vancomycin-resistant enterococci (VRE) have become a major concern in medical practice. Asymptomatic VRE colonization of the gastrointestinal tract may lead to infection. In this study, which included patients who stayed in our hospital between 2006 and 2011, we looked at the cases of 342 patients with VRE colonization and 19 patients with VRE infection. Vancomycin and carbapenem exposure and intestinal disorders were significantly more common in patients with VRE infection than in those with VRE colonization (p=0.02/0.04/0.04 respectively). Secondary immune deficiency was significantly more common in VRE-colonized patients than in VRE-infected patients (p=0.03). VRE colonization time was significantly related with young age, presence of intravenous catheter, presence of mechanical ventilation, length of hospital stay, length of hospitalization before and after VRE isolation, length of ICU stay before and after VRE isolation, total ICU stay, antibiotic exposure within 3 months, hospitalization (in our hospital) within 3 months, and having a site of infection other than VRE (p=0.01/ 0.01/ 0.04/ <0.001/ 0.02/ <0.001/ 0.002/ 0.006/ 0.002/ 0.004/ 0.01/ 0.002, respectively). Overall mortality and sepsis was more common in the VRE-infected group than in the VRE-colonized group. Taking into consideration limiting antibiotic usage in potential cases and screening for patients at risk could be beneficial in terms of limiting VRE infection and colonization. [ABSTRACT FROM AUTHOR]

• Two new phytoecdysteroidal glycosides were isolated from Sphenocentrum jollyanum. • Activity against Aspergillus fumigatus Pinh and Vancomycin resistant enterococcus. • The ethyl acetate fraction showed activity against A. fumigatus (IC 50 < 8 µg/mL). • Identification of all isolated compounds by spectral data analyses. The crude methanol extract of Sphenocentrum jollyanum root exhibited 98% and 80% antimicrobial activity against Aspergillus fumigatus Pinh and Vancomycin resistant enterococcus (VRE) at a concentration of 200 µg/mL, with IC 50 11.45 and 12.95 µg/mL, respectively. The ethyl acetate fraction of methanol extract showed in-vitro antimicrobial activity against A. fumigatus Pinh at 83% with IC 50 of <8 µg/mL. The phytochemical investigation of ethyl acetate fraction yielded six compounds, which were identified by their NMR, IR and MS spectral analyses as two new phytoecdysteroidal glycosides Sphenocentroside A (1), and Sphenocentroside B (2), and four known phytoecdysteroids: polypodoaurein (3), polypodine B (4), ecdysterone (5), and 20, 26-dihydroxyecdysone (6). [ABSTRACT FROM AUTHOR]

The gastrointestinal microbiome is intrinsically linked to the spread of antibiotic resistance. Antibiotic treatment puts patients at risk for colonization by opportunistic pathogens like vancomycin resistant Enterococcus and Clostridioides difficile by destroying the colonization resistance provided by the commensal microbiota. Once colonized, the host is at a much higher risk for infection by that pathogen. Furthermore, we know that microbiome community differences are associated with disease states, but we do not have a good understanding of how we can use these changes to classify different patient populations. To that end, we have performed a multicenter retrospective analysis on patients who received fecal microbiota transplants to treat recurrent Clostridioides difficile infection. We performed 16S rRNA gene sequencing on fecal samples collected as part of this study and used these data to develop a microbiome disruption index. Our microbiome disruption index is a simple index that is predictive across cohorts, indications, and batch effects. We are able to classify pre-fecal transplant vs post-fecal transplant samples in patients with recurrent C. difficile infection, and we are able to predict, using previously-published data from a cohort of patients receiving hematopoietic stem cell transplants, which patients would go on to develop bloodstream infections. Finally, we also identified patients in this cohort that were initially colonized with vancomycin resistant Enterococcus and that 92% (11/12) were decolonized after the transplant, but the microbiome disruption index was unable to predict such decolonization. We, however, were able to compare the relative abundance of different taxa between the two groups, and we found that increased abundance of Enterobacteriaceae predicts whether patients were colonized with vancomycin resistant Enterococcus. This work is an early step towards a better understanding of how microbiome predictors can be used to help improve patient care and patient outcomes., Competing Interests: Conflict of interest: MS, ZK, ST, and MBS are employees of Finch Therapeutics Group Inc. JRA consults for and had research support from Finch Therapeutics Group. AG is a consultant for Merck. The authors declare no conflicts of interest in this paper.

Vancomycin-resistant enterococcus (VRE) is now one of the leading causes of nosocomial infections in the United States. Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of VRE colonization and infection. VRE has emerged as a major cause of bacteremia in this population, raising important clinical questions regarding the role and impact of VRE colonization and infection in HSCT outcomes as well as the optimal means of prevention and treatment. We review here the published literature and scientific advances addressing these thorny issues and provide a rational framework for their approach., Competing Interests: No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

Vancomycin-resistant enterococci are serious health threats due in part to their ability to persist in rugged environments and their propensity to acquire antibiotic resistance determinants. Enterococci have now established a home in our hospitals and possess mechanisms to defeat most currently available antimicrobials. This article reviews the history of the struggle with this pathogen, what is known about the traits associated with its rise in the modern medical environment, and the current understanding of therapeutic approaches in severe infections caused by these microorganisms. As the 21st century progresses, vancomycin-resistant enterococci continue to pose a daunting clinical challenge., (Copyright © 2016 Elsevier Inc. All rights reserved.)