Vancomycin-resistant enterococci. This bacterium, highly adapted to the hospital environment, is already in Salvador and continues to worry specialists because of the difficulty in fighting it. According to the technical note released by the State Nucleus for Hospital Infection Control, of the Bahia Health Department (Sesab), three hospitals in Salvador have already had cases between January and March 2022.
Habits during the Covid-19 pandemic may have been preponderant in the spread of antimicrobial-resistant microorganisms in health services. They can survive on inanimate surfaces for long periods. Already, in humans and other animals, they make up the microbiota of the gastrointestinal tracts and genitourinary system, in addition to the oral cavity, according to Sesab.
“Increase in the number and length of hospitalization of patients with Covid-19; critically ill patients with prolonged use of invasive devices and intensive care; reduction in the number of health professionals and increased workload; difficulties in implementing prevention measures and infection control (lack of human resources, scarcity and inadequate use of Personal Protective Equipment – PPE, etc.); excessive and empirical use of broad-spectrum antimicrobials, on a large scale, for the treatment of secondary, fungal or bacterial infections”, score.
Infectologist Clarissa Cerqueira pointed out that, in Bahia, the frequency of the bacteria was reduced. “Enterococcus can colonize the intestinal tract, usually people already have it in the intestine. This bacterium is already resistant to some antibiotics. We are certainly seeing more resistance in the community because of this. People started to use a lot of antibiotics, people already have this bacterium in general”, he explained to BN.
“It exists, but we consider it in hospitalized patients. Resistance in the hospital environment that we have to protect. It can be more harmful for people who have central access, who are intubated, for hospitalized patients it is a greater danger. we isolate, you don’t have to leave it isolated. But in the hospital you need it. A professional who doesn’t take precautions properly, the patient has access. It increases hospitalization time, morbidity and mortality”, he commented.
One of the biggest difficulties is also the cost of treatment. “When it becomes resistant to vancomycin, we only have two more therapeutic options. There are two antibiotics. They are very expensive, they have a very big damage, very expensive drugs. Vancomycin is a basic drug, but when it becomes resistant, it is daptomycin and linezolid. but a box [da linezolida] costs R$ 3 thousand”, pointed out the specialist.
And already taking into account the epidemiological scenario, Sesab points out that it is “imperative to know the real magnitude of these microorganisms in the State”. “We alert health services to the mandatory notification of multidrug-resistant microorganisms”, he adds.
According to State Ordinance No. 1589/2010, and Technical Note NECIH/COVIM/DIVISA No. 02/2019 dealing with the Measures for the Prevention and Control of Infections Related to Health Care by Multi-Drug-Resistant Microorganisms in Health Services in the State of Bahia , the state asks that measures be directed to the control of strains of Enterococcus sp resistant to vancomycin, given the epidemiological importance and magnitude of this public health problem.
Among the measures are: applying contact precautions in outbreak situations; hand hygiene and training/education in hand hygiene for the application of the multimodal strategy recommended by the WHO. In addition, there is the need for internal auditing and the return of monitoring results to care units as a way to improve the adherence of professionals.
“Promptly identify patients already known to be colonized at hospital admission through a tracking system; implement standardized environmental cleaning and disinfection procedures with hypochlorite-based products on room surfaces and 70% alcohol for equipment, and monitor performance for ensure the efficiency of the process; if possible, dedicate medical equipment for the exclusive use of colonized/infected patients; implement an Antimicrobial Use Management Program; perform routine culture in patients with infection; perform active surveillance culture to investigate colonization with pre-defined criteria defined by patient group; keep colonized/infected patients in a private room or cohort”, he adds.
As it is not possible to keep all patients in a private room, prioritize those at greatest risk of transmission – use of invasive devices, antibiotics. “Keep an exclusive team for the care of colonized/infected patients”, he concludes.