title: A polyclonal outbreak of predominantly VanB vancomycin-resistant enterococci in northeast Ohio. Northeast Ohio Vancomycin-Resistant Enterococcus Surveillance Program.
abstract: We studied the molecular epidemiology of vancomycin-resistant enterococci (VRE) isolated in northeast Ohio during 1996 and examined the association between isolation of VRE from samples other than stool and antimicrobial purchases for five Cleveland hospitals. Susceptibility testing and pulsed-field gel electrophoresis were used to analyze 363 isolates from individual patients from 13 hospitals. Susceptibility testing indicated that 287 strains (79%) expressed the VanB phenotype and 76 (21%) expressed the VanA phenotype. The outbreak was polyclonal, with 30 total genotypes. Both VanA and VanB VRE demonstrated multiple genotypes. One genotype was present in all hospitals, suggesting spread between hospitals. For five teaching hospitals, rates of isolation from non-stool sources and from blood correlated positively with purchases of ticarcillin/clavulanic acid (P = .005). In summary, this outbreak demonstrates transmission of VRE between several hospitals in a geographic region and suggests that use of certain beta-lactam antibiotics may be associated with an increased prevalence of VRE.
authors.affiliation: Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Donskey
authors.forename: J R
authors.initials: JR
authors.lastname: Schreiber
authors.forename: M R
authors.initials: MR
authors.lastname: Jacobs
authors.forename: R
authors.initials: R
authors.lastname: Shekar
authors.forename: R A
authors.initials: RA
authors.lastname: Salata
authors.forename: S
authors.initials: S
authors.lastname: Gordon
authors.forename: C C
authors.initials: CC
authors.lastname: Whalen
authors.forename: F
authors.initials: F
authors.lastname: Smith
authors.forename: L B
authors.initials: LB
authors.lastname: Rice
mesh_terms: D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D016983:Enterococcus / Q000235:genetics* / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000235:genetics / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D020713:Vancomycin Resistance