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A Cluster of Vancomycin-Resistant Enterococcus faecium in an Intensive Care Unit

Published online by Cambridge University Press:  21 June 2016

Lynne V. Karanfil ,
Mary Murphy ,
Adele Josephson ,
Robert Gaynes ,
Laura Mandel ,
Bertha C. Hill  and
Jana M. Swenson
Lynne V. Karanfil*
Affiliation:
Epidemiology Department, University Hospital
Mary Murphy
Affiliation:
Infectious Disease Division, Department of Medicine
Adele Josephson
Affiliation:
Epidemiology Department, University Hospital
Robert Gaynes
Affiliation:
SUNY-Health Science Center at Brooklyn, and the, Hospital Infections Program, Centers for Disease Control
Laura Mandel
Affiliation:
Infectious Disease Division, Department of Medicine
Bertha C. Hill
Affiliation:
SUNY-Health Science Center at Brooklyn, and the, Hospital Infections Program, Centers for Disease Control
Jana M. Swenson
Affiliation:
SUNY-Health Science Center at Brooklyn, and the, Hospital Infections Program, Centers for Disease Control
*
The Johns Hopkins Hospital, Department of Infection Control, 600 North Wolfe Street/ParkB112, Baltimore, MD 21205
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Abstract

Objective:

To describe the epidemiology of a cluster of vancomycin-resistant Enterococcus faecium (VAREC) in a cardiothoracic surgery intensive care unit.

Design:

A case series of patients identified through review of surveillance data on nosocomial infections, review of microbiologic records, and culture survey of patients in the unit.

Results:

Six patients in the cardiothoracic surgery intensive care unit had VAREC with identical antimicrobic susceptibility patterns over a 6-month period. Four patients were identified with VAREC through prospective surveillance and 2 through retrospective review. Prior vancomycin use was seen more commonly in patients with VAREC (6/6,100%) than in those without VAREC (3/12, 25%) (Fisher’s exact test, p= .01). Six of the 7 patients with prior infection developed VAREC (85.7%). A prior nosocomial infection and prior exposure to vancomycin were found to be important variables in a logistic regression analysis. VAREC also was isolated from the environment. Acombination of cohorting of patients and staff, and modifications of standard contact isolation practices eliminated the presence of VAREC from the cardiothoracic surgery intensive care unit.

Conclusions:

The results suggest that prior administration of vancomycin, especially in the patient who develops nosocomial infection, can influence the acquisition of vancomycin-resistant enterococci and that VAREC may be transmitted from patient to patient. Using a modification of the standard infection control practice of isolation, we were able to control the spread of this resistant strain of E faecium.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 4 , April 1992 , pp. 195 - 200
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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