title: First nosocomial outbreak of vanA-type vancomycin-resistant Enterococcus raffinosus in France.
abstract: BACKGROUND
  Vancomycin-resistant Enterococcus raffinosus has rarely been associated with nosocomial infection and outbreaks.
  
  
  OBJECTIVE
  To report the successful control of a nosocomial outbreak of vanA-type vancomycin-resistant E. raffinosus in a surgical intensive care unit.
  
  
  METHODS
  The investigation of the outbreak is reported with control measures taken. Molecular typing of vancomycin-resistant E. raffinosus isolates was performed by repetitive sequence-based polymerase chain reaction (PCR).
  
  
  RESULTS
  Between September and October 2014, vancomycin-resistant E. raffinosus isolates were isolated from four patients. The index patient had been hospitalized previously in Portugal, and was not found to be colonized by vancomycin-resistant enterococci on screening cultures obtained at admission. However, vancomycin-resistant E. raffinosus was isolated from a bile sample 19 days after hospital admission. All four isolates were resistant to both vancomycin and teicoplanin due to the presence of the vanA gene, while remaining susceptible to daptomycin and linezolid. Repetitive sequence-based PCR confirmed the spread of a single vanA-positive E. raffinosus clone. Infection control measures including direct PCR screening on rectal specimens, contact precautions, and cohorting of patients and personnel led to successful control of the outbreak.
  
  
  CONCLUSIONS
  This is the first reported outbreak of vanA-type vancomycin-resistant E. raffinosus in France in both clinical and screening specimens among hospitalized patients. The inability of routine selective screening media to detect the vancomycin-resistant E. raffinosus in the index case likely contributed to the outbreak.
authors.affiliation: Unité de Contrôle, d'Epidémiologie et de Prévention de l'Infection, Groupe Henri Mondor-Albert Chenevier, Assistance Publique - Hôpitaux de Paris, Créteil Cedex, France; UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France. Electronic address: sarah.jolivet@aphp.fr.
authors.forename: S
authors.initials: S
authors.lastname: Jolivet
authors.affiliation: CHU de Caen, Service de Microbiologie, Caen Cedex, France; CNR de la Résistance aux Antibiotiques (Laboratoire Associé'Entérocoques et résistances particulières des bactéries à Gram positif'), Caen Cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Fines-Guyon
authors.affiliation: Service de Bactériologie-Virologie-Hygiène, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil Cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Nebbad
authors.affiliation: Unité de Réanimation Chirurgicale Digestive, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil Cedex, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Merle
authors.affiliation: Unité de Contrôle, d'Epidémiologie et de Prévention de l'Infection, Groupe Henri Mondor-Albert Chenevier, Assistance Publique - Hôpitaux de Paris, Créteil Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Le Pluart
authors.affiliation: Unité de Contrôle, d'Epidémiologie et de Prévention de l'Infection, Groupe Henri Mondor-Albert Chenevier, Assistance Publique - Hôpitaux de Paris, Créteil Cedex, France; UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France; Service de Bactériologie-Virologie-Hygiène, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil Cedex, France.
authors.forename: J-W
authors.initials: JW
authors.lastname: Decousser
authors.affiliation: CHU de Caen, Service de Microbiologie, Caen Cedex, France; CNR de la Résistance aux Antibiotiques (Laboratoire Associé'Entérocoques et résistances particulières des bactéries à Gram positif'), Caen Cedex, France; Université de Caen Normandie, EA 4655 (équipe 'Antibio-résistance'), Caen Cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Cattoir
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics*; D001431:Bacteriological Techniques / Q000379:methods; D019729:Carbon-Oxygen Ligases / Q000235:genetics*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005602:France / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D065507:Vancomycin-Resistant Enterococci / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D001426:Bacterial Proteins; C071437:VanA ligase, Bacteria; D019729:Carbon-Oxygen Ligases
keywords: Enterococcus raffinosus; Infection control; Intensive care unit; Outbreak; Vancomycin-resistant enterococci