Objective:To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.Interventions:Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistantEnterococcus faeciumdespite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection ofvanA andvanBresistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).Results:A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistantE. faecium.Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).Conclusion:Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.

Staphylococcus epidermidis is an important pathogen involved in health care-associated bloodstream infections and infections related to vascular catheters and prosthetic devices (17). Several investigations have demonstrated that certain multidrug-resistant S. epidermidis (MDRSE) genotypes become established as opportunistic pathogens in the health care setting as a novel ecological niche (8,10,12). In addition, recent studies identified several worldwide epidemic clonal lineages (9,12,13,18,21). Currently, little information is available on the molecular epidemiology of S. epidermidis in the health care setting in Australia (16,18).We have previously documented the occurrence and potential dissemination of two genotypes of MDRSE in 11 hospitals in northern Europe between 2001 and 2008. The aims of this study were to examine the molecular epidemiology of clinical isolates of MDRSE collected in a teaching hospital in Australia and determine the possible presence of previously described health careassociated MDRSE clones.

The cellular fatty acid profiles of newly described campylobacters were determined on a polar, capillary cQlumnI. Six isolates of the gastric spiral organism, Campylobacter pylori subsp. mustelae, from ferrets from Australia, England, and the United States were all found to have a similar fatty acid profile which was different from that of C. pylori from humans; C. pylori subsp. mustelae did not have 3-hydroxyoctadecanoic acid (3-OH C18:0) and had much less tetradecanoic acid (C14:0) and much more hexadecanoic acid (C16:0). Inasmuch as

In Western Australia clearance rates of H. pylori infection, after one week of BTM or LAM, are lower than in other published series. The high incidence of metronidazole resistance is the main determinant of our relatively poor eradication rates.

John W Peannan • MB BS FRCPA MD MSc(Lond) MASM Clinical Microbiologist Adjunct Professor,