title: [Vancomycin-resistant Enterococcus in an epidemic situation: screening at admission for patients at risk of carriage].
abstract: OBJECTIVE
  To evaluate a strategy based on screening and isolation at admission to a department of infectious diseases during an epidemic of vancomycin-resistant Enterococcus (VRE) at the University Hospital of Clermont-Ferrand.
  
  
  METHODS
  Systematic screening for VRE by anal swabs began on November 15, 2004. Patients were isolated on admission if (a) they had been hospitalized more than 24 h in an at-risk department of our hospital or (b) they had received a course of wide-spectrum antimicrobial therapy for longer than 48 h in the three months preceding admission. Patients hospitalized in our department were screened weekly if they were treated with wide-spectrum antibiotics, had a urinary catheter left in place for one week, or were neutropenic.
  
  
  RESULTS
  Through May 15, 2005, 12 (3.5%) of 341 swabs were found to be positive for VRE: eight were detected on admission and four during hospitalization. In all, 81 patients were isolated on admission. A case-control study confirmed that the criteria for patient isolation were indeed risk factors for VRE. Isolation was well accepted when it was clearly explained. No new case has been detected since March 2005.
  
  
  CONCLUSIONS
  An isolation strategy based on known risk factors for VRE with systematic screening on admission appears to be an effective way to control an outbreak of VRE, perhaps in part because it helps to keep the medical staff alert to this problem. Isolation is well tolerated as long as it is explained clearly.
authors.affiliation: Service des maladies infectieuses et tropicales, CHU de Clermont-Ferrand, France. olivier.lessens@wanadoo.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesens
authors.forename: Frédéric
authors.initials: F
authors.lastname: Robin
authors.forename: Violaine
authors.initials: V
authors.lastname: Corbin
authors.forename: Magali
authors.initials: M
authors.lastname: Vidal
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Sanchis
authors.forename: Florence
authors.initials: F
authors.lastname: Julien
authors.forename: Florence
authors.initials: F
authors.lastname: Gourdon
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Romaszko
authors.forename: Louis
authors.initials: L
authors.lastname: Cormerais
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Ousmane
authors.initials: O
authors.lastname: Traore
authors.forename: Jean
authors.initials: J
authors.lastname: Beytout
authors.forename: Henri
authors.initials: H
authors.lastname: Laurichesse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000635:transmission*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology* / Q000627:therapeutic use*
chemical_list: D014640:Vancomycin