title: Vancomycin-resistant Enterococci in Singaporean hospitals: 5-year results of a multi-centre surveillance programme.
abstract: BACKGROUND
  Vancomycin-resistant enterococci (VRE) have emerged as one of the major nosocomial antimicrobial-resistant pathogens globally. In this article, we describe the epidemiology of VRE in Singaporean public hospitals in the 5 years following the major local VRE outbreak in 2005.
  
  
  METHODS
  A passive laboratory surveillance programme identified non-duplicate VRE isolates from 7 hospitals from 2006 to 2010. Descriptive statistics and time-series analysis was performed on all clinical VRE isolates for each individual hospital as well as for the combined dataset.
  
  
  RESULTS
  There were a total of 418 VRE isolates over 5 years, of which 102 isolates (24.4%) were from clinical cultures. Between 0.4% and 0.7% of all clinical enterococcal isolates were resistant to vancomycin. The overall incidence-density of VRE did not change over time in Singapore despite 2 separate outbreaks in tertiary hospitals in 2009 and 2010. Incidence-density of clinical VRE cases fell in 2 secondary hospitals, while another 2 hospitals experienced no significant VRE infections after 2008.
  
  
  CONCLUSIONS
  The prevalence of VRE clinical isolates remains low in Singaporean public sector hospitals. However, the presence of at least 2 outbreaks in separate hospitals over the past 5 years indicates the need for continued vigilance in order to prevent any further increase in VRE prevalence locally.
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore.
authors.forename: Yiying
authors.initials: Y
authors.lastname: Cai
authors.forename: Joey P J
authors.initials: JP
authors.lastname: Chan
authors.forename: Dale Andrew
authors.initials: DA
authors.lastname: Fisher
authors.forename: Li Yang
authors.initials: LY
authors.lastname: Hsu
authors.forename: Tse Hsien
authors.initials: TH
authors.lastname: Koh
authors.forename: Prabha
authors.initials: P
authors.lastname: Krishnan
authors.forename: Andrea L H
authors.initials: AL
authors.lastname: Kwa
authors.forename: Thean Yen
authors.initials: TY
authors.lastname: Tan
authors.forename: Nancy W S
authors.initials: NW
authors.lastname: Tee
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology*; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D006779:Hospitals, Public; D006801:Humans; D011159:Population Surveillance; D012846:Singapore / Q000453:epidemiology; D014640:Vancomycin / Q000627:therapeutic use; D020713:Vancomycin Resistance / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin