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Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital

Published online by Cambridge University Press:  02 January 2015

Keryn J. Christiansen ,
Patricia A. Tibbett ,
William Beresford ,
John W. Pearman ,
Rosie C. Lee ,
Geoffrey W. Coombs ,
Ian D. Kay ,
Frances G. O'Brien ,
Silvano Palladino  and
Charles R. Douglas
...Show all authors
Keryn J. Christiansen*
Affiliation:
Royal Perth Hospital, Perth, Western Australia Curtin University of Technology, Perth, Western Australia
Patricia A. Tibbett
Affiliation:
Royal Perth Hospital, Perth, Western Australia
William Beresford
Affiliation:
Women's & Children's Health Service, Perth, Western Australia
John W. Pearman
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Rosie C. Lee
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Geoffrey W. Coombs
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Ian D. Kay
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Frances G. O'Brien
Affiliation:
Curtin University of Technology, Perth, Western Australia
Silvano Palladino
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Charles R. Douglas
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Philip D. Montgomery
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Terri Orrell
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Allison M. Peterson
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Frank P. Kosaras
Affiliation:
Royal Perth Hospital, Perth, Western Australia
James P. Flexman
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Christopher H. Heath
Affiliation:
Royal Perth Hospital, Perth, Western Australia
Cheryll A. McCullough
Affiliation:
Royal Perth Hospital, Perth, Western Australia
*
Microbiology & Infectious Diseases, Royal Perth Hospital, Wellington St., Perth, Western Australia6000
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Abstract

Objective:

To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.

Interventions:

Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistant Enterococcus faecium despite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection of vanA and vanB resistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).

Results:

A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistant E. faecium. Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).

Conclusion:

Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 5 , May 2004 , pp. 384 - 390
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance System report: data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2001;29:404–421.CrossRefGoogle Scholar
2.Tornieporth, NG, Roberts, RB, John, J, Hafner, A, Riley, LW. Risk factors associated with vancomycin-resistant Enterococcus faecium infection or colonization in 145 matched case patients and control patients. Clin Infect Dis 1996;23:767–772.CrossRefGoogle ScholarPubMed
3.Stroud, L, Edwards, J, Danzing, L, Culver, D, Gaynes, R. Risk factors for mortality associated with enterococcal bloodstream infections. Infect Control Hosp Epidemiol 1996;17:576–580.Google Scholar
4.Shay, DK, Maloney, SA, Montecalvo, M, et al.Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995;172:993–1000.CrossRefGoogle ScholarPubMed
5.Garbutt, JM, Ventrapragada, M, Littenberg, B, Mundy, LM. Association between resistance to vancomycin and death in cases of Enterococcus faecium bacteremia. Clin Infect Dis 2000;30:466–472.Google Scholar
6.Bhavnani, SM, Drake, JA, Forrest, A, et al.A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis 2000;36:145–158.CrossRefGoogle ScholarPubMed
7.Lodise, TP, McKinnon, PS, Tarn, VH, Rybak, MJ. Clinical outcomes for patients with bacteremia caused by vancomycin-resistant enterococcus in a level 1 trauma center. Clin Infect Dis 2002;34:922–929.Google Scholar
8.Carmeli, Y, Eliopoulos, G, Mozaffari, E, Samore, M. Health and economic outcomes of vancomycin-resistant enterococci. Arch Intern Med 2002;162:2223–2228.Google Scholar
9.Recommendations for preventing the spread of vancomycin resistance. MMWR 1995;44(RR-12):1–13.Google Scholar
10.Lai, KK, Kelley, AL, Melvin, ZS, Belliveau, PP, Fontecchio, SA. Failure to eradicate vancomycin-resistant enterococci in a university hospital and the cost of barrier precautions. Infect Control Hosp Epidemiol 1998;19:647–652.CrossRefGoogle Scholar
11.Quale, J, Landman, D, Atwood, E, et al.Experience with a hospital-wide outbreak of vancomycin-resistant enterococci. Am J Infect Control 1996;24:372–379.Google Scholar
12.Byers, KE, Anglim, AM, Anneski, CJ, et al.A hospital epidemic of vancomycin-resistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001;22:140–147.Google Scholar
13.Muto, CA, Giannetta, ET, Durbin, LJ, Simonton, BM, Farr, BM. Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002;23:429–435.Google Scholar
14.Boyce, JM, Opal, SM, Chow, JW, et al.Outbreak of multidrug-resistant Enterococcus faecium with transferable VanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
15.Timmers, GJ, van der Zwet, WC, Simoons-Smit, IM, et al.Outbreak of vancomycin-resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic. Br J Haematol 2002;116:826–833.CrossRefGoogle Scholar
16.Hanna, H, Umphrey, J, Tarrand, J, Mendoza, M, Raad, I. Management of an outbreak of vancomycin-resistant enterococci in the medical intensive care unit of a cancer center. Infect Control Hosp Epidemiol 2001;22:217–219.Google Scholar
17.Falk, PS, Winnike, J, Woodmansee, C, Desai, M, Mayhall, CG. Outbreak of vancomycin-resistant enterococci in a burn unit. Infect Control Hosp Epidemiol 2000;21:575–582.CrossRefGoogle Scholar
18.Ostrowsky, BE, Trick, WE, Sohn, AH, et al.Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med 2001;344:1427–1433.CrossRefGoogle ScholarPubMed
19.Turnidge, JD, Nimmo, GR, Francis, G. Evolution of resistance in Staphylococcus aureus in Australian teaching hospitals. Med J Aust 1996;164:68–71.CrossRefGoogle ScholarPubMed
20.Quale, J, Landman, D, Saurina, G, Atwood, E, DiTore, V, Patel, K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis 1996;23:1020–1025.Google Scholar
21.Palladino, S, Kay, ID, Costa, AM, Lambert, EJ, Flexman, JP. Real-time PCR for the rapid detection of vanA and vanB genes. Diagn Microbiol Infect Dis 2002;45:81–84.Google Scholar
22.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing: Twelfth Informational Supplement. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002. M100-12.Google Scholar
23.Kulski, JK, Wilson, RD, Bending, R, Grubb, WB. Antibiotic resistance and genomic analysis of enterococci in an intensive care unit and general wards. Pathology 1998;30:68–72.Google Scholar
24.Townsend, DE, Ashdown, N, Bolton, S, Grubb, WB. The use of cetyltrimethylammonium bromide for the isolation from Staphylococcus aureus of relaxable and non-relaxable DNA for invitro manipulation. Lett Appl Microbiol 1985;1:207–212.Google Scholar
25.Bruce, J. Automated system rapidly identifies and characterizes microorganisms in food. Food Technology 1996;50:77–81.Google Scholar
26.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
27.World Health Organization Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) Index With Defined Daily Doses (DDDs). Oslo, Norway: World Health Organization Collaborating Centre for Drug Statistics Methodology; 2002.Google Scholar
28.Weber, DJ, Rutala, WA. Role of environmental contamination in the transmission of vancomycin resistant enterococci. Infect Control Hosp Epidemiol 1997;18:306–309.Google Scholar
29.Zachary, KC, Bayne, PS, Morrison, VJ, Ford, DS, Silver, LC, Hooper, DC. Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2001;22:560–564.Google Scholar
30.Opal, SM, Mayer, KH, Stenberg, MJ, et al.Frequent acquisition of multiple strains of methicillin-resistant Staphylococcus aureus by healthcare workers in an endemic hospital environment. Infect Control Hosp Epidemiol 1990;11:479–485.CrossRefGoogle Scholar
31.Cookson, B, Peters, B, Webster, M, Phillips, I, Rahman, M, Noble, W. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1989;27:1471–1476.CrossRefGoogle ScholarPubMed
32.D'Agata, EM, Gautam, S, Green, WK, Tang, YW. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis 2002;34:167–172.CrossRefGoogle ScholarPubMed
33.Bradley, SJ, Wilson, AL, Allen, MC, Sher, HA, Goldstone, AH, Scott, GM. The control of hyperendemic glycopeptide-resistant Enterococcus spp. on a haematology unit by changing antibiotic usage. J Antimicrob Chemother 1999;43:261–266.Google Scholar
34.Edmond, MB, Ober, JF, Dawson, JD, Weinbaum, DL, Wenzel, RP. Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin Infect Dis 1996;23:1234–1239.Google Scholar
35.Stosor, V, Peterson, LR, Postelnick, M, Noskin, GA. Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med 1998;158:522–527.CrossRefGoogle Scholar
36.Noble, WC, Virani, Z, Cree, RG. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett 1992;72:195–198.Google Scholar
37.Centers for Disease Control and Prevention. Staphylococcus aureus resistant to vancomycin: United States, 2002. MMWR 2002;51:565–567.Google Scholar
38.Centers for Disease Control and Prevention. Public Health Dispatch: vancomycin-resistant Staphylococcus aureus—Pennsylvania, 2002. MMWR 2002;51:902.Google Scholar