Controlling an Unprecedented Outbreak with Vancomycin-Resistant Enterococcus faecium in Germany, October 2015 to November 2019

Abstract

Hospital outbreaks with vancomycin-resistant enterococci (VRE) pose a serious health threat and a challenge to infection prevention and control (IPC). We herein report on a VRE outbreak of unprecedented extent in Southern Germany (October 2015–November 2019). We used descriptive epidemiology and whole-genome sequencing (WGS) for a detailed outbreak investigation. Of the 2905 cases, 2776 (95.3%) were colonized, whereas from 127 (3.7%), VRE could be isolated from otherwise sterile body fluids or sites unlikely for enterococci colonization. Cases had a median age of 78 years (IQR 68–84) and 1339/2905 (46%) were female. The majority of isolates sequenced belonged to the clonal lineage ST80/CT1013 (212/397, 53%). Nosocomial transmission was observed as well as the constant import of VRE into the hospital. Extensive IPC measures were implemented and terminated the outbreak in late 2019, eventually. Our study shows that the combination of epidemiological and genomic analyses is indispensable for comprehensive outbreak investigations. The adaptation of IPC measures to these findings, their timely implementation, and strict execution also allow containment of large VRE outbreaks in hospital settings.

Vancomycin-resistant enterococci (VRE) in hospital settings across European borders: a scoping review comparing the epidemiology in the Netherlands and Germany

“…Of the 12 studies conducted in the Netherlands, eight were outbreak reports (Table 1 ) [ 34 – 41 ]. Of the 32 German publications, six were outbreak reports (Table 2 ) [ 42 – 47 ]. All outbreaks in both countries were caused by VREfm.…”

“…All outbreaks in both countries were caused by VREfm. In three of eight outbreaks observed in Dutch hospitals and in four of six outbreaks observed in German hospitals, VREfm infections were reported alongside patients colonized with VREfm [ 34 , 37 , 40 , 42 , 45 – 47 ]. One common factor observed in these reports was that colonization played a pivotal role in the occurrence of outbreaks in both countries.…”

Analysis of the Distribution and Drug Resistance of Pathogens in Patients with Urinary Tract Infection in the Eastern Chongming Area of Shanghai from 2018 to 2020

“…6,15 To make matters worse, these positive cocci can cause serious nosocomial infections that are difficult to control. 16,17 Among reports of nosocomial infections associated with vancomycin-resistant Enterococcus, most of the sequenced isolates belonged to the clonal lineage ST80/CT1013 in Germany, while the Dutch report was ST117, and the Chinese report was ST78, ST192, and ST570. [17][18][19] The distribution and drug resistance of bacteria vary greatly in different countries and regions.…”

“…16,17 Among reports of nosocomial infections associated with vancomycin-resistant Enterococcus, most of the sequenced isolates belonged to the clonal lineage ST80/CT1013 in Germany, while the Dutch report was ST117, and the Chinese report was ST78, ST192, and ST570. [17][18][19] The distribution and drug resistance of bacteria vary greatly in different countries and regions. Active surveillance can alert people to the spread of resistant strains.…”

Molecular and Clinical Data of Antimicrobial Resistance in Microorganisms Producing Bacteremia in a Multicentric Cohort of Patients with Cancer in a Latin American Country

“…Long-term mortality has also been observed among patients with urological or colorectal malignancies [ 36 ]. Additionally, there is a considerable risk of outbreaks of these MDR microorganisms that might put a large number of patients in danger [ 37 ].…”