title: Epidemiology and control of an outbreak of vancomycin-resistant enterococci in the intensive care units.
abstract: OBJECTIVE
  This study was aimed to describe a vancomycin-resistant enterococci (VRE) outbreak across three intensive care units (ICUs) of a Korean hospital from September 2006 to January 2007 and the subsequent control strategies.
  
  
  METHODS
  We simultaneously implemented multifaceted interventions to control the outbreak, including establishing a VRE cohort ward, active rectal surveillance cultures, daily extensive cleaning of environmental surfaces and environmental cultures, antibiotic restriction, and education of hospital staff. We measured weekly VRE prevalence and rectal acquisition rates and characterized the VRE isolates by polymerase chain reaction (PCR) of the vanA gene and Sma1-pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  During the outbreak, a total of 50 patients infected with VRE were identified by clinical and surveillance cultures, and 46 had vancomycin-resistant Enterococcus faecium (VREF). PFGE analysis of VREF isolates from initial two months disclosed 6 types and clusters of two major types. The outbreak was terminated 5 months after implementation of the interventions: The weekly prevalence rate decreased from 9.1/100 patients-day in September 2006 to 0.6/100 by the end of January 2007, and the rectal acquisition rates also dropped from 6.9/100 to 0/100 patients-day.
  
  
  CONCLUSIONS
  Our study suggests that an aggressive multifaceted control strategy is a rapid, effective approach for controlling a VRE outbreak.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Yoon
authors.forename: Hee Sun
authors.initials: HS
authors.lastname: Sim
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Park
authors.forename: Jang Wook
authors.initials: JW
authors.lastname: Sohn
authors.forename: Kyung Ho
authors.initials: KH
authors.lastname: Roh
authors.forename: Seung Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Min Ja
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D003666:Decontamination; D004196:Disease Outbreaks / Q000517:prevention & control*; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007362:Intensive Care Units; D010356:Patient Isolation; D015995:Prevalence; D020713:Vancomycin Resistance