title: Outbreak of vanB vancomycin-resistant Enterococcus faecium colonization in a neonatal service.
abstract: OBJECTIVE
  To describe successful termination of an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) colonization within a neonatal service.
  
  
  METHODS
  Multisite neonatal intensive care unit and special care nurseries within a single health care service.
  
  
  METHODS
  Forty-four cases of VREfm-colonized neonatal inpatients-including 2 clinical isolates (eye swab and catheter-urine specimen) and 42 screening isolates.
  
  
  METHODS
  Active surveillance cultures, patient isolation, contact precautions, enhanced environment cleaning, and staff and parent education. Whole genome sequencing and multilocus sequence typing were used to characterize the outbreak and refine infection control procedures.
  
  
  RESULTS
  Peak prevalence of VREfm colonization across all sites was 31% upon discovery of the outbreak. Subsequent to the intervention, transmission was halted within 8 weeks and no further isolates of the outbreak strain have been detected as of 12 months following outbreak cessation. Environmental swabs revealed VREfm colonization of baby-weighing scales, a baby bath, and a pharmacy refrigerator within the neonatal intensive care unit. All isolates were of a single multilocus sequence type (sequence type 796) and highly clonal at the core genome level.
  
  
  CONCLUSIONS
  Bundled infection control interventions were effective in rapidly terminating a clonal outbreak of sequence type 796 VREfm colonization within a neonatal inpatient service. Strain-typing and active surveillance cultures were critical in guiding the management of this outbreak. The closed environment of a neonatal unit likely facilitated eradication of the patient and environment reservoirs of VREfm colonization.
authors.affiliation: Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia. Electronic address: david.michael.lister@gmail.com.
authors.forename: David M
authors.initials: DM
authors.lastname: Lister
authors.affiliation: Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.
authors.forename: Despina
authors.initials: D
authors.lastname: Kotsanas
authors.affiliation: Department of Microbiology, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Ballard
authors.affiliation: Department of Microbiology, Austin Health, Heidelberg, Victoria, Australia; Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia; Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Howden
authors.affiliation: Monash Childrens Hospital, Monash Health, Clayton, Victoria, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Carse
authors.affiliation: Monash Childrens Hospital, Monash Health, Clayton, Victoria, Australia.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tan
authors.affiliation: Department of Infection Prevention & Epidemiology, Monash Health, Clayton, Victoria, Australia.
authors.forename: Carmel
authors.initials: C
authors.lastname: Scott
authors.affiliation: Department of Infection Prevention & Epidemiology, Monash Health, Clayton, Victoria, Australia.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Gillespie
authors.affiliation: Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Mahony
authors.affiliation: Monash Childrens Hospital, Monash Health, Clayton, Victoria, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Doherty
authors.affiliation: Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.
authors.forename: Tony M
authors.initials: TM
authors.lastname: Korman
authors.affiliation: Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Paul D R
authors.initials: PD
authors.lastname: Johnson
authors.affiliation: Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia; Department of Infection Prevention & Epidemiology, Monash Health, Clayton, Victoria, Australia.
authors.forename: Rhonda L
authors.initials: RL
authors.lastname: Stuart
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D016984:Enterococcus faecium / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D016680:Genome, Bacterial; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D007363:Intensive Care Units, Neonatal; D008297:Male; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D017422:Sequence Analysis, DNA; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*
chemical_list: D001426:Bacterial Proteins; C079913:VanB protein, Enterococcus
keywords: Environment cleaning; Infection control; Neonates; Whole genome sequencing