Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 142 No. 2122 (2012)

Vancomycin-resistantEnterococcus

  • Clara Thierfelder
  • Peter Michael Keller
  • Claudine Kocher
  • Roman Gaudenz
  • Michael Hombach
  • Guido Vincent Bloemberg
  • Christian Ruef
DOI
https://doi.org/10.4414/smw.2012.13540
Cite this as:
Swiss Med Wkly. 2012;142:w13540
Published
20.05.2012

Abstract

The reported prevalence of vancomycin-resistant Enterococcus faecium (VRE) in Switzerland for the years 2008–2010 has been low at <5%. At the University Hospital Zurich, 17 cases of VRE were detected between 28 December 2009 and 15 February 2010. Nine cases were diagnosed clinically; eight cases were detected by rectal screening. The centre of the outbreak was the cardiac surgery department. Four patients suffered from VRE-infections; four patients died.

In order to investigate and contain the outbreak, the following measures were taken: prevalence surveys using weekly rectal screening, environmental screening; selective enrichment culturing; pulsed field gel electrophoresis (PFGE) for clonal typing and polymerase chain reaction-analysis (PCR) for resistance determinants and virulence factors detection. Contact isolation in single rooms and enhanced surface-disinfection methods were implemented. Ward nurses were assigned as link nurses. Regular teaching was carried out aiming to improve hand disinfection among healthcare workers.

PFGE revealed two main pulsotypes each including seven patients. Five minor pulsotypes originated from three additional patients and one sample collected from a keyboard. Two of three patients with minor pulsotypes had been treated abroad. PCR-analysis identified vanB resistance-genotypes with exception of one vanA resistance-genotype.

The outbreak was associated with environmental contamination and insufficient compliance with hand-hygiene. Enhanced awareness and infection control measures resulted in termination of the VRE outbreak within eight weeks. The complexity of the outbreak with several clones in parallel suggests a higher baseline prevalence of VRE in Switzerland than previous surveillance data indicate.

References

  1. Balzereit-Scheuerlein F, Stephan R. Prevalence of colonisation and resistance patterns of vancomycin-resistant enterococci in healthy, non-hospitalised persons in Switzerland. Swiss Med Wkly. 2001;131:280–2.
  2. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470–85.
  3. Werner G, Coque TM, Hammerum AM, Hope R, Hryniewicz W, Johnson A, et al. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill. 2008;13:1–11.
  4. Performance standards for antimicrobial susceptibility testing; twentieth informational supplement (June 2010 Update)2010. Report No.: 1-56238-729-4
  5. Chang CM, Wang LR, Lee HC, Lee NY, Wu CJ, Ko WC. Characterisation of vancomycin-resistant enterococci from hospitalised patients at a tertiary centre over a seven-year period. J Hosp Infect. 2010;74:377–84.
  6. Fleisch F, Oechslin EC, Gujer AR, Ritzler E, Imhof A, Ruef C, et al. Transregional spread of a single clone of methicillin-resistant Staphylococcus aureus between groups of drug users in Switzerland. Infection. 2005;33:273–7.
  7. Johnson PD, Ballard SA, Grabsch EA, Stinear TP, Seemann T, Young HL, et al. A sustained hospital outbreak of vancomycin-resistant Enterococcus faecium bacteremia due to emergence of vanB E. faecium sequence type 203. J Infect Dis. 2010;202:1278–86.
  8. Ergani_Ozcan A, Naas T, Baysan BO, Ogunc D, Inan D, Colak D, et al. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium in a paediatric unit at a Turkish university hospital. J Antimicrob Chemother. 2008;61:1003–9.
  9. Klare I, Konstabel C, Mueller-Bertling S, Werner G, Strommenger B, Kettlitz C, et al. Spread of ampicillin/vancomycin-resistant Enterococcus faecium of the epidemic-virulent clonal complex-17 carrying the genes esp and hyl in German hospitals. Eur J Clin Microbiol Infect Dis. 2005;24:815–25.
  10. Byers KE, Anglim AM, Anneski CJ, Germanson TP, Gold HS, Durbin LJ, et al. A hospital epidemic of vancomycin-resistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol. 2001;22:140–7.
  11. Martinez JA, Ruthazer R, Hansjosten K, Barefoot L, Snydman DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med. 2003;163:1905–12.
  12. Kolar M, Vagnerova I, Latal T, Urbanek K, Typovska H, Hubacek J, et al. The occurrence of vancomycin-resistant enterococci in hematological patients in relation to antibiotic use. New Microbiol. 2002;25:205–12.
  13. Bonten MJ, Hayden MK, Nathan C, van Voorhis J, Matushek M, Slaughter S, et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet. 1996;348:1615–9.
  14. Wendt C, Wiesenthal B, Dietz E, Ruden H. Survival of vancomycin-resistant and vancomycin-susceptible enterococci on dry surfaces. J Clin Microbiol. 1998;36:3734–6.
  15. Huang SS, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med. 2006;166:1945–51.
  16. Vonberg RP, Chaberny IF, Kola A, Mattner F, Borgmann S, Dettenkofer M, et al. Prävention und Kontrolle der Ausbreitung von Vancomycin-resistenten Enterokokken. Anaesthesist. 2007;56:151–7.
  17. Tenover FC, Swenson JM, O’Hara CM, Stocker SA. Ability of commercial and reference antimicrobial susceptibility testing methods to detect vancomycin resistance in enterococci. J Clin Microbiol. 1995;33:1524–7.
  18. Grabsch EA, Ghaly-Derias S, Gao W, Howden BP. Comparative study of selective chromogenic (chromID VRE) and bile esculin agars for isolation and identification of vanB-containing vancomycin-resistant enterococci from feces and rectal swabs. J Clin Microbiol. 2008;46:4034–6.
  19. Pearman JW. 2004 Lowbury Lecture: the Western Australian experience with vancomycin-resistant enterococci – from disaster to ongoing control. J Hosp Infect. 2006;63:14–26.
  20. Aumeran C, Baud O, Lesens O, Delmas J, Souweine B, Traore O. Successful control of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in France. Eur J Clin Microbiol Infect Dis. 2008;27:1061–4.
  21. Ergani-Ozcan A, Naas T, Baysan BO, Ogunc D, Inan D, Colak D, et al. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium in a paediatric unit at a Turkish university hospital. J Antimicrob Chemother. 2008;61:1033–9.
  22. Pereira GH, Muller PR, Zanella RC, de Jesus Castro Lima M, Torchio DS, Levin AS. Outbreak of vancomycin-resistant enterococci in a tertiary hospital: the lack of effect of measures directed mainly by surveillance cultures and differences in response between Enterococcus faecium and Enterococcus faecalis. Am J Infect Control. 2010;38:406–9.
  23. Furuno JP, McGregor JC, Harris AD, Johnson JA, Johnson JK, Langenberg P, et al. Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med. 2006;166:580–5.
  24. Marner ES, Wolk DM, Carr J, Hewitt C, Dominguez LL, Kovacs T, et al. Diagnostic accuracy of the Cepheid GeneXpert vanA/vanB ver. 1.0 to detect the vanA and van B vancomycin reistance genes in Enterococcus from perianal specimens. Diagn Microbiol Infect Dis. 2011;69:382–0.
  25. Gazin M, Lammens C, Goossens H, Malhotra-Kumar S. Evaluation of GeneOhm VanR and Xpert vanA/van B molecular assays for the rapid detection of vancomycin-reistant enterococci. Eur J Clin Microbiol Infect Dis. 2011;Jun 12. [Epub ahead of print].
  26. Hombach M, Pfyffer GE, Roos M, Lucke K. Detection of methicillin-resistant Staphylococcus aureus (MRSA) in specimens from various body sites: performance characteristics of the BD GeneOhm MRSA assay, the Xpert MRSA assay, and broth-enriched culture in an area with a low prevalence of MRSA infections. J Clin Microbiol. 2010;48:3882–7.

Most read articles by the same author(s)