Intensified strategies to control vancomycin-resistant enterococci in immunocompromised patients

Area of Science:

• Infectious Diseases
• Microbiology
• Hospital Epidemiology

Background:

• Vancomycin-resistant enterococci (VRE) pose a significant threat to immunocompromised patients, leading to increased mortality.
• Current contact precautions are often insufficient to rapidly contain VRE spread.
• Hematologic/oncologic units are particularly vulnerable to VRE outbreaks due to patient susceptibility.

Purpose of the Study:

• To investigate a vancomycin-resistant enterococci (VRE) outbreak in a hematologic/oncologic unit.
• To identify the molecular characteristics of the outbreak strain.
• To evaluate the effectiveness of infection control interventions.

Main Methods:

• Retrospective analysis of a VRE outbreak involving 33 patients.
• Multiple-locus variable-number tandem repeat analysis (MLVA) for molecular typing.
• Implementation and assessment of intensified infection control measures including quarantine and cohorting.

Main Results:

• The outbreak was caused by VanA gene-positive Enterococcus faecium (MLVA genogroup C1) with the esp virulence factor.
• Intensified infection control measures terminated the outbreak within 2 months.
• Discontinuation of measures led to VRE spread recurrence, which was controlled by resuming interventions.

Conclusions:

• Intensive infection control strategies are crucial for timely VRE outbreak termination, even with highly transmissible strains.
• Sustained implementation of infection control measures is necessary to prevent VRE recurrence.
• Hematologic/oncologic units require robust and continuous infection control protocols to manage VRE.