http://informahealthcare.com/jmf ISSN: 1476-7058 (print), 1476-4954 (electronic) J Matern Fetal Neonatal Med, Early Online: 1–4 ! 2014 Informa UK Ltd. DOI: 10.3109/14767058.2014.958462 ORIGINAL ARTICLE A new risk factor for neonatal vancomycin-resistant Enterococcus colonisation: bacterial probiotics Sevilay Topcuoglu, Tugba Gursoy, Fahri Ovalı, Ozge Serce, and Guner Karatekin Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children’s Training and Research Hospital, Istanbul, Turkey Abstract Objective: Vancomycin-resistant Enterococcus (VRE) colonisation can be controlled with strict adherence to infection control measures. We describe a VRE outbreak coincident with bacterial probiotic trial. Relationship between probiotic and VRE colonisation, and other possible risk factors were investigated. Methods: Two hundred and ten infants with gestational age less than 32 weeks had been randomised for a trial with probiotic preparation containing Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus plantarum, Bifidobacterium lactis, fructooligosaccharide, galactooligo- saccharide, colostrums and lactoferrin (NBL probiotic ATP Õ ; Nobel, Istanbul, Turkey) between February 2012 and August 2013 when a VRE outbreak also took place. The existence of a relationship between this probiotic preparation and VRE colonisation was investigated. Results: The begining and end of the outbreak were coincident with the beginning and end of the probiotic trial. Demographic and clinical features of neonates did not differ between VRE colonised (n ¼ 94) and non-colonised infants (n ¼ 116) except for vancomycin (p ¼ 0.012) and probiotic (p50.001) use. Conclusions: Probiotic and vancomycin exposure were significant risk factors for VRE colonisation. The acquisition and transfer of resistance genes of bacteria may be mediated by probiotics. Therefore, the safety of probiotics is a concern and should be investigated further. Keywords Newborn, probiotics, vancomycin-resistant Enterococcus History Received 25 June 2014 Accepted 22 August 2014 Published online 19 September 2014 Introductıon Vancomycin-resistant enterococci (VRE) colonisation is common in intensive care units and can lead to nosocomial infections that are difficult to treat. Transmission from an infected source may cause VRE colonisation or infection. Colonisation in neonates is mostly associated with prematur- ity, low birth weight, long-term antibiotic therapy, especially with vancomycin and cephalosporins, prolonged mechanical ventilation, and use of vascular catheters [1–4]. VanA and VanB, the two major resistance phenotypes in VRE, encode cell wall precursors that vancomycin cannot bind and therefore cannot inhibit the cell wall production [5]. Enterococci have both capacity of acquiring and disseminating these vanco- mycin-resistant genes in between Enterococcus species or the other microorganisms [6,7]. Lactobacillus species are commensal bacteria but also have probiotic features and were generally considered as safe for human being [8]. According to a recent meta-analysis, enteral supplementation of probiotics including Lactobacillus species prevents severe necrotising enterocolitis and mortality in preterm infants [9]. However, the resistance gene reservoir hypothesis suggests that commensal bacteria may play a major role in the transfer of antibiotic resistance to pathogenic or opportunistic bacterial population [10,11]. Glycopeptide- resistant gene transfer between probiotic bacteria and enterococci was shown in mice intestine [12]. Moreover, presence of antibiotic pressure may enhance the transfer of these genetic determinants [12–14]. Relationship between probiotic and VRE colonisation, and other possible risk factors for VRE colonisation are investigated in this report. Methods Outbreak and management This observative study was conducted at Zeynep Kamil Maternity and Children’s Education and Training Hospital. The neonatal intensive care unit (NICU) is a 60 bed unit accepting only inborn infants with approximately 1500 annual admissions. The NICU is settled on two floors with three main rooms housing approximately 15 infants per room, three isolation rooms, and four mother–infant pair rooms. There are two entrances for each room and two basins for hand washing at Address for correspondence: Sevilay Topcuoglu, Zeynep Kamil Kadın ve C ¸ ocuk Hastalıkları Eg ˘itim ve Ara¸ stırma Hastanesi, Opr. Dr. Burhaneddin Ustunel Cad. No: 10, Uskudar, Istanbul 34668, Turkey. Tel: 90 216 391 0680; ext. 1105. Fax: 90 216 391 0690. E-mail: sevilaymd@yahoo.com J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by Hacettepe Univ. on 09/22/14 For personal use only.