title: Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin.
abstract: In October 1990, Enterococcus faecium that was highly resistant to glycopeptides, penicillins, and aminoglycosides was isolated from the peritoneal dialysis fluid from a patient in an intensive care unit. Over the following 6 months, multiresistant E. faecium organisms were isolated from cultures of blood, urine, or surgical wound specimens from eight additional patients. Surveillance cultures of groin and/or rectal swabs were positive for eight of 37 patients and four of 62 employees at risk. Restriction endonuclease digestion of chromosomal DNA from outbreak isolates was consistent with dissemination of a single strain throughout the intensive care unit. Strict infection control interventions contained the outbreak after several weeks. Review of patient charts suggested that renal insufficiency, length of hospital stay, duration of antibiotic treatment, and prior treatment with vancomycin were risks for infection due to multiresistant E. faecium. The emergence of multiple-drug-resistant enterococci presents serious infection control and therapeutic dilemmas.
authors.affiliation: Division of Infectious Diseases, Beth Israel Medical Center, New York, New York.
authors.forename: S
authors.initials: S
authors.lastname: Handwerger
authors.forename: B
authors.initials: B
authors.lastname: Raucher
authors.forename: D
authors.initials: D
authors.lastname: Altarac
authors.forename: J
authors.initials: J
authors.lastname: Monka
authors.forename: S
authors.initials: S
authors.lastname: Marchione
authors.forename: K V
authors.initials: KV
authors.lastname: Singh
authors.forename: B E
authors.initials: BE
authors.lastname: Murray
authors.forename: J
authors.initials: J
authors.lastname: Wolff
authors.forename: B
authors.initials: B
authors.lastname: Walters
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission; D004269:DNA, Bacterial / Q000032:analysis / Q000302:isolation & purification; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development; D005260:Female; D005839:Gentamicins / Q000494:pharmacology*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D015183:Restriction Mapping; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D004269:DNA, Bacterial; D005839:Gentamicins; D014640:Vancomycin