title: Elimination of vancomycin-resistant enterococci from a neonatal intensive care unit following an outbreak.
abstract: A policy of weekly faecal cultures for vancomycin-resistant enterococci (VRE) was instituted following the investigation of an outbreak of VRE in our neonatal intensive care unit in 2005. We found that 11 of 18 patients were infected or colonised during the outbreak, including three cases of bloodstream infection and one case of meningitis. This report describes the utility of the surveillance policy in maintaining a VRE-free environment. The outbreak investigation showed that all VRE isolated were Enterococcus faecium of the vanA type. Pulsed-field gel electrophoresis suggested that the outbreak was caused by a single strain. Control of the outbreak was achieved by enhanced contact isolation precautions, cohorting of patients and staff, improved environmental decontamination and closure of the unit to new admissions. The patients with bloodstream infections and meningitis were treated successfully with linezolid. Approximately one year after the outbreak, weekly surveillance detected two patients with faecal carriage of VRE whose periods of admission overlapped. Early intensive intervention was associated with disappearance of the organism from the neonatal intensive care unit. No further cases of colonisation or disease have occurred in the unit in the two and a half years since then.
authors.affiliation: Department of Neonatology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel. zivanit@hadassah.org.il
authors.forename: Z
authors.initials: Z
authors.lastname: Ergaz
authors.forename: I
authors.initials: I
authors.lastname: Arad
authors.forename: B
authors.initials: B
authors.lastname: Bar-Oz
authors.forename: O
authors.initials: O
authors.lastname: Peleg
authors.forename: S
authors.initials: S
authors.lastname: Benenson
authors.forename: N
authors.initials: N
authors.lastname: Minster
authors.forename: A
authors.initials: A
authors.lastname: Moses
authors.forename: C
authors.initials: C
authors.lastname: Block
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D016172:DNA Fingerprinting; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D015931:Intensive Care, Neonatal; D007557:Israel / Q000453:epidemiology; D008297:Male; D020713:Vancomycin Resistance; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C071437:VanA ligase, Bacteria; D019729:Carbon-Oxygen Ligases