title: Long-term control of vancomycin-resistant Enterococcus faecium at the scale of a large multihospital institution: a seven-year experience.
abstract: Repeated outbreaks of vancomycin-resistant Enterococcus faecium (VRE) occurred between 2004 and 2010 in Assistance Publique--Hôpitaux de Paris (AP-HP), a 23,000-bed multi-hospital institution. From August 2004 to December 2005, the French guidelines for preventing cross-transmission of multiresistant bacteria were applied. Because the number of VRE cases continued to increase, an institutional control programme was implemented from January 2006 onwards: it foresees stopping transfer of VRE and contact patients, separating VRE and contact patients in distinct cohorts, intervention of a central infection control team to support local teams, and quick application of measures as soon as first VRE cases are identified. Between August 2004 and December 2010, 45 VRE outbreaks occurred in 21 of the 38 AP-HP hospitals, comprising 533 cases. Time series analysis showed that the mean number of cases increased by 0.8 cases per month (95% confidence interval (CI): 0.3 to 1.3, p=0.001) before, and decreased by 0.7 cases per month after implementation of the programme (95% CI: -0.9 to -0.5, p<0.001), resulting in a significant trend change of -1.5 cases per month (95% CI: -2.1 to -0.9, p<0.001). The number of cases per outbreak was significantly lower after implementation of the programme. A sustained and coordinated strategy can control emerging bacteria at the level of a large regional multihospital institution.
authors.affiliation: Direction de la Politique Medicale-Directorate of Medical Politics, Assistance Publique-Hopitaux de Paris, Paris, France. sandra.fournier@sap.aphp.fr
authors.forename: S
authors.initials: S
authors.lastname: Fournier
authors.forename: F
authors.initials: F
authors.lastname: Brossier
authors.forename: N
authors.initials: N
authors.lastname: Fortineau
authors.forename: F
authors.initials: F
authors.lastname: Gillaizeau
authors.forename: A
authors.initials: A
authors.lastname: Akpabie
authors.forename: A
authors.initials: A
authors.lastname: Aubry
authors.forename: F
authors.initials: F
authors.lastname: Barbut
authors.forename: F X
authors.initials: FX
authors.lastname: Chedhomme
authors.forename: N
authors.initials: N
authors.lastname: Kassis-Chikhani
authors.forename: J C
authors.initials: JC
authors.lastname: Lucet
authors.forename: J
authors.initials: J
authors.lastname: Robert
authors.forename: D
authors.initials: D
authors.lastname: Seytre
authors.forename: I
authors.initials: I
authors.lastname: Simon
authors.forename: D
authors.initials: D
authors.lastname: Vanjak
authors.forename: J R
authors.initials: JR
authors.lastname: Zahar
authors.forename: C
authors.initials: C
authors.lastname: Brun-Buisson
authors.forename: V
authors.initials: V
authors.lastname: Jarlier
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control*; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D005602:France / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008826:Microbial Sensitivity Tests; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D014640:Vancomycin / Q000494:pharmacology; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin