Successful control of vancomycin-resistant <i>Enterococcus faecium</i> outbreak in a neurosurgical unit at non-endemic region

Abstract

Vancomycin-resistant enterococci (VRE) have emerged in many parts of the world, but have only been reported sporadically in Hong Kong. We report an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) in a neurosurgical unit at a tertiary teaching hospital between 3 March and 3 April 2009 in Hong Kong. During the outbreak investigation, clinical samples from 193 (91.5%) of 211 patients who had stayed in the neurosurgical unit and 506 environmental samples were screened for VREfm. Besides the index case, another 3 (1.6%) out of 192 patients were found to be positive for VREfm. Two (0.4%) out of 506 environmental samples were positive for VREfm. All four clinical and two environmental isolates were found to be clonally related by pulse-field gel electrophoresis. The risk factors for nosocomial acquisition of VREfm included advanced age (P=0.047), presence of nasogastric tubing (P=0.002) and tracheostomy (P<0.001), and the use of β-lactam antibiotics (P<0.001) and vancomycin (P=0.001). Contrary to other VRE outbreaks in which the spread was rapid, the neurosurgical patients’ immobilization because of coma and mechanical ventilation dependency, and the vigilant practice of hand hygiene by health-care workers successfully limited the number of secondary cases despite the delayed recognition of the index case. All patients with VREfm were labeled in the hospital network information system so that stringent infection control measures with contact precautions would be carried out once these patients were readmitted to prevent its spread in our locality.

Structure-Activity Relationship and Mode of Action of a Frog Secreted Antibacterial Peptide B1CTcu5 Using Synthetically and Modularly Modified or Deleted (SMMD) Peptides

“…The exact mechanism by which they kill the bacteria or the ways they exhibit toxicity against mammalian cells are not fully understood. Considering the increasing incidence of emergence of new bacterial strains with the ability to resist the action of conventional antibiotics, there is an immediate requirement for novel drug molecules [ 10 ]. AMPs are the most potent choice to design novel antibiotics to fight against bacterial infection because of their broad spectrum activity and the unique mode of action.…”

Strategic measures for the control of surging antimicrobial resistance in Hong Kong and mainland of China

“…Introduction of directly observed hand hygiene in clinical settings may be a better option, where a designated healthcare assistant or nurse delivers alcohol-based hand rub to all conscious patients and healthcare workers once every 2–3 h. This practice appeared to be useful in the prevention of nosocomial outbreaks due to epidemiologically important viruses or MDROs in our setting. 90 , 91 , 97 , 107 , 108 , 109 , 110 , 111 , 112 …”