Outbreak of vancomycin-resistant enterococci in a burn unit

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Epidemiology

Background:

• Vancomycin-resistant enterococci (VRE) pose a significant threat in healthcare settings, particularly in intensive care units.
• Burn intensive care units (BICUs) are vulnerable to healthcare-associated infections due to the compromised skin barrier and prolonged patient stays.

Purpose of the Study:

• To investigate the epidemiology and implement control measures for a vancomycin-resistant enterococci (VRE) outbreak in a burn intensive care unit (BICU).
• To identify risk factors associated with VRE acquisition and determine effective eradication strategies.

Main Methods:

• Conducted epidemiological investigations including patient and environmental cultures, healthcare worker hand hygiene monitoring, and pulsed-field gel electrophoresis (PFGE) for isolate typing.
• Performed a case-control study to identify independent risk factors for VRE acquisition.
• Implemented barrier isolation and aggressive environmental decontamination protocols.

Main Results:

• A 13-month outbreak involving 21 patients with VRE colonization and 4 with bacteremia was caused by a single VRE clone.
• Diarrhea and antacid administration were identified as independent risk factors for VRE acquisition.
• Despite initial eradication, the outbreak recurred from a contaminated electrocardiogram lead, emphasizing persistent environmental reservoirs.

Conclusions:

• A single clone of VRE caused the protracted outbreak in the BICU.
• Recrudescence of the outbreak underscored the importance of identifying and eliminating subtle environmental contamination sources.
• Aggressive environmental decontamination and barrier isolation were effective in eradicating VRE from the burn patient population.