Rapid control of an outbreak of vancomycin-resistant enterococci in a French university hospital.
Vancomycin-resistant enterococci (VRE) are emerging in French hospitals. A VRE outbreak occurred in our hospital, prompting efforts to eradicate the organism. The following interventions were implemented simultaneously to control the outbreak: (1) creation of a VRE control committee; (2) cohorting of VRE carriers in a dedicated ward; (3) extensive screening of contact patients; (4) use of a sensitive technique for detecting VRE in rectal samples; (5) intervention of a dedicated team to reduce consumption of selected antibiotics; (6) information for, and education of, all hospital staff; and (7) electronic tracking of in-hospital transfer and readmission of VRE carriers and contact patients. Over a four-week period following admission of the index case, 37 carriers of a single strain of vanA vancomycin-resistant Enterococcus faecium were identified across seven units. A single additional readmitted contact patient was identified later. Of the 39 VRE-positive patients, two had urinary tract infections and 37 were colonised. Of the 32 patients with known VRE stool concentrations, 23 had low and nine high concentrations. One low-concentration patient precipitated transmission in another unit. This aggressive, co-ordinated, multifaceted strategy was successful in halting a widespread VRE outbreak in our hospital.
Lucet
J-C
JC
Infection Control Unit, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. jean-christophe.lucet@bch.aphp.fr
Armand-Lefevre
L
L
Laurichesse
J-J
JJ
Macrez
A
A
Papy
E
E
Ruimy
R
R
Deblangy
C
C
Lozach
A
A
Lolom
I
I
Jarlier
V
V
Andremont
A
A
Leport
C
C
D002353:Carrier State; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control*; D016984:Enterococcus faecium / Q000187:drug effects* / Q000235:genetics; D005243:Feces / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D010297:Paris / Q000453:epidemiology; D010356:Patient Isolation; D018571:Sentinel Surveillance; D020713:Vancomycin Resistance