title: Outbreak of vancomycin-resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic.
abstract: 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.
authors.affiliation: Department of Haematology, VU University Medical Centre, Amsterdam, the Netherlands. GJ.Timmers@VUMC.nl
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: Timmers
authors.forename: Wil C
authors.initials: WC
authors.lastname: van der Zwet
authors.forename: Ina M
authors.initials: IM
authors.lastname: Simoons-Smit
authors.forename: Paul H M
authors.initials: PH
authors.lastname: Savelkoul
authors.forename: Helena H M
authors.initials: HH
authors.lastname: Meester
authors.forename: Christina M J E
authors.initials: CM
authors.lastname: Vandenbroucke-Grauls
authors.forename: Peter C
authors.initials: PC
authors.lastname: Huijgens
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D012709:Serum Albumin; D014769:Virginiamycin; C062940:quinupristin-dalfopristin