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JAC Advance Access published online on July 23, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm270
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Outbreak of hospital-adapted clonal complex-17 vancomycin-resistant Enterococcus faecium strain in a haematology unit: role of rapid typing for early control

A. Deplano1,*, O. Denis1, C. Nonhoff1, F. Rost2, B. Byl2, F. Jacobs3, V. Vankerckhoven4, H. Goossens4,5 and M. J. Struelens1

1 Department of Microbiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium 2 Department of Infection Control, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium 3 Department of Infectious Diseases, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium 4 Department of Medical Microbiology, University of Antwerp, Antwerp, Belgium 5 Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands

Received 1 February 2007; returned 11 April 2007; revised 16 May 2007; accepted 26 June 2007

* Corresponding author. Tel: +32-2-555-69-71; Fax: +32-2-555-31-10; E-mail: ariane.deplano{at}ulb.ac.be

Objectives: To describe the investigation and molecular characterization of a vancomycin-resistant Enterococcus faecium (VREF) strain responsible for a nosocomial outbreak in the haematology unit of a tertiary-care university hospital.

Patients and methods: Two patients admitted to the haematology unit developed infection/colonization with VREF over a 3 month period when compared with none in the 2 previous years. On the basis of the identification of a clonal link between these two strains, weekly rectal screening was implemented for all patients in the haematology unit and contact precautions were extended to VREF carriers. In the following 6 month period, 11 patients colonized with VREF were detected. No further case was detected in the following 1 year period.

Results: VREF isolates from the haematology unit carried the vanA gene and were multiresistant to antimicrobial agents, including high-level resistance to vancomycin, teicoplanin and ampicillin. This resistance profile restricted the choice of antimicrobial therapy to linezolid or investigational drugs such as tigecycline. Molecular analysis showed that 11 of 13 (85%) VREF isolates belonged to pandemic clonal complex-17 carrying the esp and hyl virulence genes.

Conclusions: Rapid typing and infection control measures, including early reinforcement of barrier precautions combined with weekly rectal surveillance cultures, were followed by control of nosocomial spread of this VREF clone.

Key Words: ST16 , epidemic , ampicillin resistance , vanA


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