Epidemiology and control of an outbreak of vancomycin-resistant enterococci in the intensive care units

Kyung Yoon Young, Sun Sim Hee, Yeon Kim Jeong, Won Park Dae, Wook Sohn Jang, Ho Roh Kyung, Eun Lee Seung, Ja Kim Min

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21 Citations (Scopus)

Abstract

Purpose: 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. Materials and Methods: 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). Results: 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. Conclusion: Our study suggests that an aggressive multifaceted control strategy is a rapid, effective approach for controlling a VRE outbreak.

Original languageEnglish
Pages (from-to)637-643
Number of pages7
JournalYonsei medical journal
Volume50
Issue number5
DOIs
Publication statusPublished - 2009 Oct

Keywords

  • Enterococcus
  • Epidemiology
  • Infection control
  • Outbreak
  • Vancomycin resistance

ASJC Scopus subject areas

  • Medicine(all)

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    Young, K. Y., Hee, S. S., Jeong, Y. K., Dae, W. P., Jang, W. S., Kyung, H. R., Seung, E. L., & Min, J. K. (2009). Epidemiology and control of an outbreak of vancomycin-resistant enterococci in the intensive care units. Yonsei medical journal, 50(5), 637-643. https://doi.org/10.3349/ymj.2009.50.5.637