title: A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit.
abstract: OBJECTIVE
  To describe the epidemiology of a cluster of vancomycin-resistant Enterococcus faecium (VAREC) in a cardiothoracic surgery intensive care unit.
  
  
  METHODS
  A case series of patients identified through review of surveillance data on nosocomial infections, review of microbiologic records, and culture survey of patients in the unit.
  
  
  RESULTS
  Six patients in the cardiothoracic surgery intensive care unit had VAREC with identical antimicrobic susceptibility patterns over a 6-month period. Four patients were identified with VAREC through prospective surveillance and 2 through retrospective review. Prior vancomycin use was seen more commonly in patients with VAREC (6/6, 100%) than in those without VAREC (3/12, 25%) (Fisher's exact test, p = .01). Six of the 7 patients with prior infection developed VAREC (85.7%). A prior nosocomial infection and prior exposure to vancomycin were found to be important variables in a logistic regression analysis. VAREC also was isolated from the environment. A combination of cohorting of patients and staff, and modifications of standard contact isolation practices eliminated the presence of VAREC from the cardiothoracic surgery intensive care unit.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Epidemiology Department, University Hospital, SUNY-Health Science Center, Brooklyn.
authors.forename: L V
authors.initials: LV
authors.lastname: Karanfil
authors.forename: M
authors.initials: M
authors.lastname: Murphy
authors.forename: A
authors.initials: A
authors.lastname: Josephson
authors.forename: R
authors.initials: R
authors.lastname: Gaynes
authors.forename: L
authors.initials: L
authors.lastname: Mandel
authors.forename: B C
authors.initials: BC
authors.lastname: Hill
authors.forename: J M
authors.initials: JM
authors.lastname: Swenson
mesh_terms: D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D009519:New York City / Q000453:epidemiology; D011159:Population Surveillance; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D014640:Vancomycin