First nosocomial outbreak of vanA -type vancomycin-resistant Enterococcus raffinosus in France

• Published in: The Journal of hospital infection Vol. 94; no. 4; pp. 346 - 350
• Main Authors: Jolivet, S, Fines-Guyon, M, Nebbad, B, Merle, J.C, Le Pluart, D, Brun-Buisson, C, Decousser, J-W, Cattoir, V
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2016
• Subjects: Bacterial Proteins - genetics; Bacteriological Techniques - methods; Carbon-Oxygen Ligases - genetics; Cross Infection - epidemiology; Cross Infection - microbiology; Disease Outbreaks; Enterococcus raffinosus; France - epidemiology; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Humans; Infection control; Infection Control - methods; Infectious Disease; Intensive care unit; Intensive Care Units; Molecular Typing; Outbreak; Polymerase Chain Reaction; Vancomycin-resistant enterococci; Vancomycin-Resistant Enterococci - classification; Vancomycin-Resistant Enterococci - genetics; Vancomycin-Resistant Enterococci - isolation & purification; Enterococcus raffinosus; Outbreak; Intensive care unit; Vancomycin-resistant enterococci; Infection control
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2016.09.004

Summary Background Vancomycin-resistant Enterococcus raffinosus has rarely been associated with nosocomial infection and outbreaks. Aim 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). Findings 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. Conclusion 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.