Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014-2017: successful control using a restrictive screening strategy
Autor: | Jan Kluytmans, Anita van Oosten, Veronica Weterings, Jolande Nelson, Andreas Voss, Ellen Nieuwkoop, Bas Wintermans, Joris van Lieshout, Jacobien Veenemans |
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Rok vydání: | 2021 |
Předmět: |
Microbiology (medical)
medicine.medical_specialty Isolation (health care) VRE Resistance Enterococcus faecium Prevalence Drug resistance Hospitals General lcsh:Infectious and parasitic diseases Disease Outbreaks Vancomycin-Resistant Enterococci Screening strategy Medical microbiology All institutes and research themes of the Radboud University Medical Center medicine Humans Infection control lcsh:RC109-216 Pharmacology (medical) General hospital Gram-Positive Bacterial Infections Netherlands Retrospective Studies Cross Infection Infection Control Isolation strategy biology business.industry Research Public Health Environmental and Occupational Health Outbreak biochemical phenomena metabolism and nutrition biology.organism_classification Infectious Diseases lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] Emergency medicine business |
Zdroj: | Antimicrobial Resistance and Infection Control, 10, 1 Antimicrobial Resistance and Infection Control Antimicrobial Resistance and Infection Control, Vol 10, Iss 1, Pp 1-10 (2021) Antimicrobial Resistance and Infection Control, 10 |
ISSN: | 2047-2994 |
Popis: | Background The emergence of vancomycin resistant enterococci poses a major problem in healthcare settings. Here we describe a hospital-wide outbreak of vancomycin-resistant Enterococcus faecium in a general hospital in The Netherlands in the period December 2014–February 2017. Due to late detection of the outbreak, a large cohort of approximately 25,000 (discharged) patients was classified as ‘VRE suspected’. Hereupon a mitigated screening and isolation policy, as compared with the national guideline, was implemented to control the outbreak. Methods After the outbreak was identified, a screening policy consisting of a single rectal swab culture (with enrichment broth) to discontinue isolation and removing ‘VRE suspected’ label in the electronic patient files for readmitted VRE suspected patients, was implemented. In addition to the on admission screening, periodic hospital-wide point prevalence screening, measures to improve compliance with standard infection control precautions and enhanced environmental cleaning were implemented to control the outbreak. Results Between September 2014 and February 2017, 140 patients were identified to be colonised by vanA mediated vancomycin-resistant Enterococcus faecium (VREfm). Two of these patients developed bacteraemia. AFLP typing showed that the outbreak was caused by a single clone. Extensive environmental contamination was found in multiple wards. Within nine months after the detection of the outbreak no new VRE cases were detected. Conclusion We implemented a control strategy based on targeted screening and isolation in combination with implementation of general precautions and environmental cleaning. The strategy was less stringent than the Dutch national guideline for VRE control. This strategy successfully controlled the outbreak, while it was associated with a reduction in the number of isolation days and the number of cultures taken. |
Databáze: | OpenAIRE |
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