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An outbreak of vanA vancomycin-resistant Enterococcus faecium in a hospital with endemic vanB VRE. | LitMetric
Background : In Australia, vanB vancomycin-resistant Enterococcus faecium (VREfm) has been endemic for over 20 years, but vanA VREfm isolates have rarely been reported.Methods : This outbreak report describes an outbreak of vanA VREfm in the intensive care unit (ICU) and cardiothoracic surgery (CTS) wards of a Melbourne hospital in 2015-2016. After the cluster was initially identified in the ICU ward, an active screening programme was implemented. VRE isolates were typed using in silico multi-locus sequence typing. In addition, to screening, enhanced environmental cleaning, chlorhexidine gluconate body washes, and standardisation of the surgical antibiotic prophylaxis regimen were implemented to control the outbreak.Results : There were 83 new isolates of vanA VREfm recovered from patients in the ICU (n = 31) and CTS (n = 52) wards. Screening identified 78 (94%) of cases. Three patients required treatment for clinical infection with vanA VREfm during the outbreak. The outbreak was polyclonal with 5 different multilocus sequence types carrying the vanA gene (ST17, ST80, ST203, ST252 and ST1421) detected from a subset of isolates (N = 43). The ST17 isolates all carried both the vanA and vanB gene. The intervention bundle resulted in control of the outbreak after 10 months.Conclusion : Geographically, vanA VREfm has previously been uncommon in the region and this outbreak represents a change in local epidemiology. Few VRE outbreaks have been reported in CTS patients. The infection control responses controlled the outbreak within 10-months and may help guide future management of outbreaks.
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