title: Identification of subclinical transmission of vancomycin-resistant enterococcus within an intensive care unit in Taiwan.
abstract: OBJECTIVE
  Colonization, infection, and clonal dissemination of vancomycin-resistant enterococcus (VRE) have been reported in the literature. We aimed to investigate the incidence rate of VRE acquisition and route of transmission of VRE within the medical intensive care unit (ICU) to prove whether subclinical transmission occurs in medical ICUs.
  
  
  METHODS
  Between March 1, 2012 and September 30, 2013, rectal cultures were obtained from all inpatients on admission and after admission to medical ICU. Strain types of VRE were determined by both multilocus sequence typing and pulsed-field gel electrophoresis.
  
  
  RESULTS
  A total of 66 of the 405 rectal swab surveillance cultures obtained from 46 inpatients were positive for VRE, among which 27 inpatients were culture-positive for VRE on admission to medical ICU, and 19 inpatients were initially culture-negative but converted to culture-positive after admission. All isolates carried vanA gene consisting of 51 Enterococcus gallinarum, 13 Enterococcus faecium, and two Eenterococcus casseliflavus. Of the 51 E. gallinarum isolates, 40 were type ST 341, seven were ST 252, two were ST 78, and two were ST 64. The Enterococcus spp., MLST and PFGE subtypes were almost similar among these two groups of inpatients. Linezolid and tigecycline were most active against VRE in vitro.
  
  
  CONCLUSIONS
  Subclinical VRE cross transmission may occur in ICU. Active surveillance and maximal barrier precautions of VRE are required at ICU with high colonization rate of VRE and shall be beneficial.
authors.affiliation: Division of Infectious Diseases, Chang Gung Memorial Hospital, Keelung, and Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan. Electronic address: Lee.sch@msa.hinet.net.
authors.forename: Sai-Cheong
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital, and Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
authors.forename: Chao-Wei
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Chang Gung Memorial Hospital, Keelung, and Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
authors.forename: Tsai-Chien
authors.initials: TC
authors.lastname: Shih
authors.affiliation: Department of Public Health, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
authors.forename: Lai-Chu
authors.initials: LC
authors.lastname: See
authors.affiliation: Department of Chest, Chang Gung Memorial Hospital, Keelung, and Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Chu
authors.affiliation: Department of Chest, Chang Gung Memorial Hospital, Keelung, and Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan.
authors.forename: Yu-Chih
authors.initials: YC
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D003428:Cross Infection / Q000453:epidemiology; D016984:Enterococcus faecium / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D000069349:Linezolid / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives / Q000627:therapeutic use; D058885:Multilocus Sequence Typing; D013624:Taiwan / Q000453:epidemiology; D000078304:Tigecycline; D014640:Vancomycin / Q000627:therapeutic use; D020713:Vancomycin Resistance; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C071437:VanA ligase, Bacteria; D014640:Vancomycin; D000078304:Tigecycline; D019729:Carbon-Oxygen Ligases; D008911:Minocycline; D000069349:Linezolid
keywords: ICU; VRE; subclinical transmission