[Vancomycin-resistant Enterococcus in an epidemic situation: screening at admission for patients at risk of carriage].
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.
Lesens
Olivier
O
Service des maladies infectieuses et tropicales, CHU de Clermont-Ferrand, France. olivier.lessens@wanadoo.fr
Robin
Frédéric
F
Corbin
Violaine
V
Vidal
Magali
M
Sanchis
Anne-Marie
AM
Julien
Florence
F
Gourdon
Florence
F
Romaszko
Jean-Pierre
JP
Cormerais
Louis
L
Souweine
Bertrand
B
Traore
Ousmane
O
Beytout
Jean
J
Laurichesse
Henri
H
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*
D014640:Vancomycin