title: Intensified strategies to control vancomycin-resistant enterococci in immunocompromised patients.
abstract: Increasing colonization and infection with vancomycin-resistant enterococci (VRE) in immunocompromised patients are associated with increased mortality. Despite contact precautions for VRE control, rapid limitation of its spread is often impossible. We report on a VRE outbreak in a hematologic/oncologic unit including 33 patients. Although 28 of the patients had only VRE colonization, VRE-related infection was probable in 4 patients, and VRE infection of the bloodstream occurred in 1 case. Two patients were identified by VRE screening on admission, 20 were identified by weekly routine VRE screening, and 6 were identified from specimens taken to clarify infections (eg, urine, bronchoalveolar lavage). Five individuals acquired VRE colonization as inpatients (contact patients). Multiple-locus variable-number tandem repeat analysis (MLVA) proved that the outbreak was caused by VanA gene-positive Enterococcus faecium belonging to MLVA genogroup C1(MLVA types 1, 7, 12). The outbreak strains exhibited the potential virulence factor esp(enterococcus surface protein). The outbreak was terminated within 2 months by intensified infection-control measures, including quarantine and the cohorting of patients who tested positive for VRE; however, VRE spread recurred after the measures were discontinued but was again limited by resuming the measures. We conclude that intensive infection-control strategies enable the timely termination of VRE outbreaks, even those involving VRE strains with high epidemic potential on "high-risk wards" (eg, hematologic/oncologic units). Premature discontinuation of infection-control measures may cause recurrence of the VRE spread.
authors: Department of Hematology, Oncology and Transfusion Medicine, Universitätsmedizin Berlin, Charité - Campus Benjamin Franklin, Berlin, Germany. martin.schmidt-hieber@charite.de
authors: M
authors: M
authors: Schmidt-Hieber
authors: I W
authors: IW
authors: Blau
authors: S
authors: S
authors: Schwartz
authors: L
authors: L
authors: Uharek
authors: K
authors: K
authors: Weist
authors: T
authors: T
authors: Eckmanns
authors: D
authors: D
authors: Jonas
authors: H
authors: H
authors: Rüden
authors: E
authors: E
authors: Thiel
authors: C
authors: C
authors: Brandt
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D004196:Disease Outbreaks; D016983:Enterococcus / Q000302:isolation & purification / Q000472:pathogenicity*; D005260:Female; D005798:Genes, Bacterial; D005838:Genotype; D006757:Hospital Units; D006801:Humans; D016867:Immunocompromised Host; D017053:Infection Control / Q000379:methods*; D007239:Infections / Q000175:diagnosis* / Q000209:etiology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications; D008297:Male; D009369:Neoplasms / Q000150:complications; D020713:Vancomycin Resistance
chemical_list: D001426:Bacterial Proteins; C071437:VanA ligase, Bacteria; D019729:Carbon-Oxygen Ligases