Emergence of linezolid- and vancomycin-resistant Enterococcus faecium in a department for hematologic stem cell transplantation.
BACKGROUND
Prevalence of vancomycin-resistant enterococci has increased in Germany. Here, we report the cluster of linezolid- and vancomycin-resistant Enterococcus faecium (LVRE) in a German department for hematologic stem cell transplantation (HSCT).


METHODS
In this retrospective analysis we included all patients with LVRE in a university-based department for HSCT in 2014 and 2015. Patients chart reviews were used to investigate the epidemiology and clinical outcome. Available LVRE isolates underwent detailed microbiological characterization and genotyping by pulsed-field gel electrophoresis (PFGE).


RESULTS
In total, 20 patients with LVRE were identified within the observed time period. All except two patients underwent allogeneic HSCT. Surveillance culture results from incoming patients and chart review revealed that 10 of 20 patients were colonized at hospital admission. Eight of 10 patients with in-hospital acquired LVRE had previous linezolid treatment. Analysis of spatio-temporal patterns showed no evidence for LVRE patient-to-patient or environment-to-patient transmission within the HSCT department. In five cases (25 %) LVRE bloodstream infection occurred. Nine LVRE isolates could be saved for characterization. Eight isolates carried vanA, one isolate vanB. PFGE analysis showed that four different LVRE clones were responsible for the cluster. One single genotype was present in six LVRE isolates whereupon the corresponding patients were all referred from the same hospital to the HSCT department.


CONCLUSIONS
This is the first report demonstrating the emergence of LVRE in a German HSCT department. (L)VRE screening at patients' admission and appropriate infection control strategies were sufficient to prevent any transmission. Further studies in this predisposed patient collective are warranted.
Hospital Hygiene, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
M
M
Krull
Wernigerode Branch, Robert Koch Institute, Wernigerode, Germany.
I
I
Klare
Hospital Hygiene, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
B
B
Ross
Department of Bone Marrow Transplantation (AHE), West German Cancer Center, University Hospital Essen, Essen, Germany.
R
R
Trenschel
Department of Bone Marrow Transplantation (AHE), West German Cancer Center, University Hospital Essen, Essen, Germany.
D W
DW
Beelen
TWINCORE Centre for Experimental and Clinical Infection Research; a joint venture between the Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Institute for Experimental Virology, Hannover, Germany.
D
D
Todt
TWINCORE Centre for Experimental and Clinical Infection Research; a joint venture between the Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Institute for Experimental Virology, Hannover, Germany.
E
E
Steinmann
Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
J
J
Buer
Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
P-M
PM
Rath
Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
J
J
Steinmann
Genotyping by PFGE; Hematologic stem cell transplantation; Linezolid-resistant VRE; VRE
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