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Eradication of a large outbreak of a single strain of vanB vancomycin‐resistant Enterococcus faecium at a major Australian teaching hospital

Christiansen, K.J., Tibbett, Pa.A., Beresford, W., Pearman, J.W., Lee, R.C., Coombs, G.W.ORCID: 0000-0003-1635-6506, Kay, I.D., O’Brien, F.G., Palladino, S., Douglas, C.R., Montgomery, P.D., Orrell, T., Peterson, A.M., Kosaras, F.P., Flexman, J.P., Heath, C.H. and McCullough, C.A. (2004) Eradication of a large outbreak of a single strain of vanB vancomycin‐resistant Enterococcus faecium at a major Australian teaching hospital. Infection Control and Hospital Epidemiology, 25 (5). pp. 384-390.

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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-resistant Enterococcus faecium despite 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 of vanA and vanB resistance 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-resistant E. faecium. Introducing additional control measures rapidly brought the out-break under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregated 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.

Item Type: Journal Article
Publisher: University of Chicago Press
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