Experience with a hospital-wide outbreak of vancomycin-resistant enterococci

Quale, John; Landman, David; Atwood, Elaine; Kreishwirth, Barry; Willey, Barbara M.; Ditore, Virginia; Zaman, Mohammed; Patel, Keval; Saurina, Guillermo; Huang, Winnie; Oydna, Elise; Burney, Sibte

doi:10.1016/s0196-6553(96)90025-5

Cited by 86 publications

(44 citation statements)

References 21 publications

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“…10,11 Maintenance of lowlevel endemicity after a large outbreak has been achieved 12,13 as has eradication following a small outbreak 14 and in specific units. [15][16][17] Successful control has also been reported in a healthcare region that included long-term-care facilities.…”

mentioning

confidence: 99%

Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

Christiansen

Tibbett

Beresford

et al. 2004

Infect. Control Hosp. Epidemiol.

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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.

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confidence: 99%

Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

Christiansen

Tibbett

Beresford

et al. 2004

Infect. Control Hosp. Epidemiol.

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“…Susceptibility testing for Enterococci isolates was performed by disk diffusion and micro dilution broth according to the clinical laboratory standard institute guideline [8]. Disk diffusion method by utilizing disks (BD BBLTM Sensi DiscTM) containing erythromycin (15μg), chloramphenicol (30μg), ciprofloxacin (5μg), gentamicin (10μg), vancomycin (30μg), teicoplanin (30μg), oxacillin (10μg), imipenem (10μg) were applied.…”

Section: Antibiotic Susceptibility Testingmentioning

confidence: 99%

“…Results were obtained after incubation at 35°C for 24 h followed by inoculation of 1.5 × 108 Cfu/mL (optical density 0.08-0.13 in 650nm) of tested isolates on Muller hint on Agar. The Minimum Inhibitory Concentration (MIC) of gentamicin, vancomycin and ciprofloxacin were also determined by the broth micro-dilution method [8]. E. faecalis strain ATCC 29212 was used as a quality control strain.…”

Section: Antibiotic Susceptibility Testingmentioning

confidence: 99%

“…Their naturally occurring or intrinsic resistance to various clinically antibiotic drugs, including penicillin and lowlevel resistance to amino glycoside appears to be due to their extraordinary capability to adapt themselves to antibiotics. They also evolved increased resistance by acquisition of antibiotic resistance to amino glycosides, glycopeptides and vancomycin [1,[4][5][6][7][8][9]. Severe unfavorable outcomes such as prolonged periods of hospital stay, costly medical expenses and increase in mortality as a consequence of limited number of choices for existing antibiotics to cure the infection are the common possible complications caused by Vancomycin Resistant Enterococci (VRE) [2,10].…”

mentioning

confidence: 99%

“…Severe unfavorable outcomes such as prolonged periods of hospital stay, costly medical expenses and increase in mortality as a consequence of limited number of choices for existing antibiotics to cure the infection are the common possible complications caused by Vancomycin Resistant Enterococci (VRE) [2,10]. Enterococcal aggregation substances (agg), gelatinase (gelE), surface protein (esp), cell wall adhesions efaAfm and efaAfs of E. faecium and E. faecalis, respectively and cytolysin (cyl) are the virulence properties detected in enterococci and have been documented in several studies [8,[11][12][13][14][15][16]. The existence of these virulence traits, intrinsic as well as acquired resistance and their role in human's infection are the possible criteria which can make these isolates as potential pathogens [17][18][19][20].…”

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confidence: 99%

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Vancomycin-Resistant Enterococci in Intensive Care Units

Ostrowsky¹,

Venkataraman²,

D’Agata³

et al. 1999

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Colonization was common and usually not recognized by clinical culture. Most patients who had colonization with VRE and were on the surgical ICU acquired VRE prior to surgical ICU entry. Exposure to second- and third-generation cephalosporins, but not vancomycin, was an independent risk factor for colonization. Prospective surveillance of hospitalized patients may yield useful insights about the dissemination of nosocomial VRE beyond what is appreciated by clinical cultures alone.

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Experience with a hospital-wide outbreak of vancomycin-resistant enterococci

Cited by 86 publications

References 21 publications

Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

Molecular Appraisement of Isolated Antibiotic Resistant Enterococci from Vaginal Specimen in Spontaneously Abortion Women’s

Vancomycin-Resistant Enterococci in Intensive Care Units

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