title: Nosocomial spread of hospital-adapted CC17 vancomycin-resistant Enterococcus faecium in a tertiary-care hospital of Beijing, China.
abstract: BACKGROUND
  The incidence of vancomycin-resistant enterococci (VRE) appeared to be increasing in China, but very few nosocomial outbreaks have been reported. Our hospital had experienced an outbreak of VRE since March 2008 to March 2009. The objective of this study was to analyze the molecular features of the isolates and the control measures used to eradicate a VRE outbreak in a tertiary institution in China.
  
  
  METHODS
  We characterized VRE isolates from 21 infected and 11 colonized inpatients from a single hospital by pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST), the analysis of Tn1546-like elements and virulence genes detection. Infection control measures, including more environmental disinfection, screening for VRE colonization, contact precautions, education and strict antibiotic restriction, were implemented to control the outbreak.
  
  
  RESULTS
  During the outbreak, a total of 32 VRE strains were obtained. There were 21 strains found in Emergency Intensive Care Unit (EICU), 9 isolates from Geriatric Ward, and two from other units. All the isolates harbored the vanA gene, however, four of them exhibited the VanB phenotype. Meanwhile, MLST analysis revealed that all isolates belonged to clonal complex (CC) 17. With the infection-control measures, the epidemic was constrained in two units (EICU and Geriatric Ward). After March 2009, no further case infected with VRE was detected in the following one-year period.
  
  
  CONCLUSIONS
  The outbreak was controlled by continuous implementation of the infection control programme, and more rigorous infection control policy is needed.
authors.affiliation: Peking Union Medical College Graduate School, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Hong-tao
authors.initials: HT
authors.lastname: Xu
authors.forename: Rui
authors.initials: R
authors.lastname: Tian
authors.forename: Dong-ke
authors.initials: DK
authors.lastname: Chen
authors.forename: Fei
authors.initials: F
authors.lastname: Xiao
authors.forename: Zhi-yang
authors.initials: ZY
authors.lastname: Nie
authors.forename: Yun-jian
authors.initials: YJ
authors.lastname: Hu
authors.forename: Xiu-zhen
authors.initials: XZ
authors.lastname: Zhang
authors.forename: Jin-ming
authors.initials: JM
authors.lastname: Li
mesh_terms: D002681:China; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity*; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000635:transmission*; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction; D020713:Vancomycin Resistance / Q000235:genetics / Q000502:physiology