Epidemiology and control of an outbreak of vancomycin-resistant enterococci in the intensive care units.
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.
Yoon
Young Kyung
YK
Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Sim
Hee Sun
HS
Kim
Jeong Yeon
JY
Park
Dae Won
DW
Sohn
Jang Wook
JW
Roh
Kyung Ho
KH
Lee
Seung Eun
SE
Kim
Min Ja
MJ
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