title: Successful control of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in France.
abstract: We describe the control of a hospital-wide vancomycin-resistant Enterococcus faecium (VRE) outbreak in a 2,000-bed university hospital located on three different sites in Clermont-Ferrand, France. From January 2004 to April 2007, 220 VRE cases were identified. Overall, 28 different wards had at least one case. All of the strains expressed a high level of resistance to vancomycin and to teicoplanin carried by the vanA gene. Pulsed-field gel electrophoresis (PFGE) analysis of the strains revealed that they were clonally related. Control measures consisted of implementing a strategy of VRE screening by rectal swab, reinforcing hand hygiene practices and taking contact precautions. Recommendations for a restricted use of specific antibiotics were sent to each physician. Alcohol-based handrubs were provided throughout the hospital and the staff underwent training for their use. Compliance with contact precautions, including the use of clean non-sterile gloves and single-use gowns, was reinforced. VRE cases were assigned systematically to a single-bed room. In October 2007, no new VRE carriage has been detected for 7 months and no clinical samples had been VRE-positive for 10 months. In conclusion, a hospital-wide VRE outbreak was successfully controlled by a strategy based on routine screening, the reinforcement of hand hygiene and taking barrier precautions.
authors.affiliation: Université Clermont1, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Aumeran
authors.forename: O
authors.initials: O
authors.lastname: Baud
authors.forename: O
authors.initials: O
authors.lastname: Lesens
authors.forename: J
authors.initials: J
authors.lastname: Delmas
authors.forename: B
authors.initials: B
authors.lastname: Souweine
authors.forename: O
authors.initials: O
authors.lastname: Traoré
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005602:France / Q000453:epidemiology; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods; D017334:Teicoplanin / Q000494:pharmacology; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D017334:Teicoplanin