A Cluster of Vancomycin-Resistant Enterococcus faecium in an Intensive Care Unit

Abstract

The results suggest that prior administration of vancomycin, especially in the patient who develops nosocomial infection, can influence the acquisition of vancomycin-resistant enterococci and that VAREC may be transmitted from patient to patient. Using a modification of the standard infection control practice of isolation, we were able to control the spread of this resistant strain of E faecium.

Guidelines for the control of glycopeptide-resistant enterococci in hospitals

“…44 This increase probably reflects a convergence of risk factors including severe illness and antimicrobial therapy. [45][46][47] The emergence of GRE in the mid 1980s coincided with an increase in the global usage of glycopeptides 48 for the treatment of MRSA and coagulase-negative staphylococci and Clostridium difficile diarrhoea. It is likely that GRE selection and spread are facilitated by increasing glycopeptide usage, although other antimicrobials have also been implicated.…”

Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programs

“…If the HCW-patient ratio is very high (e.g., one-to-one nursing), then the majority of nursing contacts can be cohorted (perhaps as much as 80%) and transmission reduced accordingly. Contact reduction of this nature has been used successfully to control several endemic ICU infections (15,(19)(20)(21)(22).…”

“…Antibiotic treatment with agents providing VRE with a selective growth͞transmission advantage, such as vancomycin or third-generation cephalosporins, has been shown to increase the risk of VRE colonization (9,22). Antibiotic restriction policies therefore may provide the potential for reducing the selection pressure (and hence probability of patient acquisition).…”

Hospital-acquired infections: diseases with increasingly limited therapies.

“…Subsequent nosocomial outbreaks due to vancomycinresistant E. faecium have occurred in several hospitals in the United States, including a cardiothoracic intensive care unit in one (47) and a medical-surgical intensive care unit in another (48). In the latter, nondisposable handles of electronic rectal thermometers were the means of spread of enterococci.…”