Eradication of a large outbreak of a single strain of vanB vancomycin-resistant Enterococcus faecium at a major Australian teaching hospital.
OBJECTIVE
To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.


METHODS
Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistant Enterococcus faecium despite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection of vanA and vanB resistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).


RESULTS
A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistant E. faecium. Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregated patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of dollar 2.7 million (Australian dollars).


CONCLUSIONS
Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.
Christiansen
Keryn J
KJ
Department, Microbiology & Infectious Diseases, Royal Perth Hospital, Wellington St., Perth, Western Australia 6000.
Tibbett
Patricia A
PA
Beresford
William
W
Pearman
John W
JW
Lee
Rosie C
RC
Coombs
Geoffrey W
GW
Kay
Ian D
ID
O'Brien
Frances G
FG
Palladino
Silvano
S
Douglas
Charles R
CR
Montgomery
Philip D
PD
Orrell
Terri
T
Peterson
Allison M
AM
Kosaras
Frank P
FP
Flexman
James P
JP
Heath
Christopher H
CH
McCullough
Cheryll A
CA
D015331:Cohort Studies; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D020713:Vancomycin Resistance; D014904:Western Australia