Outbreak of vancomycin-resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic.
We describe an outbreak of vancomycin-resistant Enterococcus faecium (VRE) on the haematology ward of a Dutch university hospital. After the occurrence of three consecutive cases of bacteraemia with VRE, strains were genotyped and found to be identical. During the next 4 months an intensive surveillance programme identified 21 additional patients to be colonized with VRE, while two more patients developed bacteraemia. A case-control study was carried out to identify risk factors for VRE acquisition. In comparison with VRE-negative control patients (n=49), cases (n=24) had a longer stay on the ward during the year preceding the outbreak (25.8 versus 10.1 d, P=0.02), more cases with acute myeloid leukaemia [11 versus 4, odds ratio (OR) 9.5, 95% confidence interval (CI95) 2.4-32.2] and higher grades of mucositis (P=0.03). Logistic regression analysis identified antibiotic use within 1 month before admission (OR 13.0, CI95 2.1-80.5, P=0.006) and low albumin levels at baseline (OR 1.2, CI95 1.1-1.3, P=0.02) to be independent risk factors. Four patients with VRE-bacteraemia were successfully treated with quinupristin/dalfopristin (Synercid). Control of the outbreak was achieved by step-wise implementation of intensive infection control measures, which included the cohorting of patients, allocation of nurses and reinforcement of hand hygiene.
Timmers
Gert Jan
GJ
Department of Haematology, VU University Medical Centre, Amsterdam, the Netherlands. GJ.Timmers@VUMC.nl
van der Zwet
Wil C
WC
Simoons-Smit
Ina M
IM
Savelkoul
Paul H M
PH
Meester
Helena H M
HH
Vandenbroucke-Grauls
Christina M J E
CM
Huijgens
Peter C
PC
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia; D016022:Case-Control Studies; D003428:Cross Infection; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D016984:Enterococcus faecium; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000635:transmission*; D006405:Hematology; D006748:Hospital Departments; D006801:Humans; D017053:Infection Control; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation; D018570:Risk Assessment; D012709:Serum Albumin / Q000032:analysis; D020713:Vancomycin Resistance; D014769:Virginiamycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D012709:Serum Albumin; D014769:Virginiamycin; C062940:quinupristin-dalfopristin