title: The relationship of a clonal outbreak of Enterococcus faecium vanA to methicillin-resistant Staphylococcus aureus incidence in an Australian hospital.
abstract: Australian isolates of vancomycin-resistant enterococci (VRE) have been widely scattered geographically, predominantly polyclonal and of the VanB phenotype. Forty-nine VRE were isolated from 47 patients in our hospital from October 1996 to December 1999. Forty-four of these VRE were Enterococcus faecium with a vanA glycopeptide resistance genotype. Four isolates were pathogenic. Thirty-five VRE were from an outbreak in the Renal and Infectious Diseases Units over a four-month period. Pulsed-field gel electrophoresis (PFGE) demonstrated that 41 of the 49 VRE were indistinguishable or closely related. Enhanced environmental cleaning, strict contact isolation of colonized patients and reducing inpatient admissions terminated the epidemic. Cohorting of methicillin-resistant Staphylococcus aureus (MRSA)-positive patients was restricted because VRE patients occupied the isolation facilities. This resulted in a statistically significant increase in MRSA infections across the hospital. VRE epidemics have the ability to influence the epidemiology of other nosocomial pathogens when infection control resources are exhausted.
authors.affiliation: Departments of Microbiology and Infectious Diseases, Princess Alexandra Hospital, Ipswich Road, Woollongabba, Brisbane, 4102, Australia.
authors.forename: P B
authors.initials: PB
authors.lastname: Bartley
authors.forename: J M
authors.initials: JM
authors.lastname: Schooneveldt
authors.forename: D F
authors.initials: DF
authors.lastname: Looke
authors.forename: A
authors.initials: A
authors.lastname: Morton
authors.forename: D W
authors.initials: DW
authors.lastname: Johnson
authors.forename: G R
authors.initials: GR
authors.lastname: Nimmo
mesh_terms: D001315:Australia / Q000453:epidemiology; D003141:Communicable Diseases / Q000150:complications; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000145:classification; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D006757:Hospital Units; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods; D007674:Kidney Diseases / Q000150:complications; D016106:Methicillin Resistance; D010641:Phenotype; D012621:Seasons; D012703:Serotyping; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D013211:Staphylococcus aureus; D020713:Vancomycin Resistance