Epidemiology and Control of an Outbreak of Vancomycin-Resistant Enterococci in the Intensive Care Units

• Published in: Yonsei medical journal Vol. 50; no. 5; pp. 637 - 643
• Main Authors: Yoon, Young Kyung, Sim, Hee Sun, Kim, Jeong Yeon, Park, Dae Won, Sohn, Jang Wook, Roh, Kyung Ho, Lee, Seung Eun, Kim, Min Ja
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 31.10.2009; 연세대학교의과대학
• Subjects: Decontamination; Disease Outbreaks - prevention & control; Enterococcus faecium - drug effects; Enterococcus faecium - isolation & purification; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - prevention & control; Humans; Intensive Care Units; Original; Patient Isolation; Prevalence; Vancomycin Resistance; 의학일반; epidemiology; outbreak; infection control; Vancomycin resistance; enterococcus
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2009.50.5.637

This study was aimed to describe a vancomycin-resistant enterococci (VRE) outbreak across three intensive care units (ICUs) of a Korean hospital from September 2006 to January 2007 and the subsequent control strategies. We simultaneously implemented multifaceted interventions to control the outbreak, including establishing a VRE cohort ward, active rectal surveillance cultures, daily extensive cleaning of environmental surfaces and environmental cultures, antibiotic restriction, and education of hospital staff. We measured weekly VRE prevalence and rectal acquisition rates and characterized the VRE isolates by polymerase chain reaction (PCR) of the vanA gene and Sma1-pulsed-field gel electrophoresis (PFGE). During the outbreak, a total of 50 patients infected with VRE were identified by clinical and surveillance cultures, and 46 had vancomycin-resistant Enterococcus faecium (VREF). PFGE analysis of VREF isolates from initial two months disclosed 6 types and clusters of two major types. The outbreak was terminated 5 months after implementation of the interventions: The weekly prevalence rate decreased from 9.1/100 patients-day in September 2006 to 0.6/100 by the end of January 2007, and the rectal acquisition rates also dropped from 6.9/100 to 0/100 patients-day. Our study suggests that an aggressive multifaceted control strategy is a rapid, effective approach for controlling a VRE outbreak.