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Molecular epidemiology of glycopeptide-resistant Enterococcus faecium on a renal unit
P R Chadwick1, A Fox, N Woodford
1Public Health Laboratory, Withington Hospital, Manchester.
Abstract:
The clinical and molecular epidemiology of glycopeptide-resistant Enterococcus faecium was investigated during an outbreak on a renal unit. Forty-nine patients were colonized or infected during a 15-month period. Sites of colonization included faeces, urine, intravenous (IV) catheter tips and wound swabs. Ten patients had infections, which included five bacteraemias and three episodes of peritonitis. Pulsed-field gel electrophoresis of 43 patient isolates of glycopeptide-resistant E. faecium identified seven strains during the first 7 months of the outbreak. Three of these strains affected five or more patients. One strain accounted for 17/43 isolates. Isolates that were possibly related to another renal unit strain were cultured from patients at two other Manchester hospitals. These isolates were epidemiologically-related, and may represent a single Manchester epidemic strain. Of five patients who had multiple isolates of glycopeptide-resistant E. faecium, three had isolates representing a single strain and two were colonized or infected by more than one strain.
Insights
An outbreak of glycopeptide-resistant Enterococcus faecium (GRE) occurred over 15 months in a renal unit. Molecular analysis identified seven GRE strains, with one dominant strain causing most infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Glycopeptide-resistant Enterococcus faecium (GRE) poses a significant threat in healthcare settings, particularly in immunocompromised patient populations.
- Renal units are vulnerable to outbreaks due to the high-risk nature of patients and frequent use of invasive devices.
Purpose of the Study:
- To investigate the clinical and molecular epidemiology of a GRE outbreak on a renal unit.
- To identify the strains involved and their transmission patterns.
Main Methods:
- Prospective investigation of colonization and infection over 15 months.
- Sample collection from various sites including faeces, urine, IV catheter tips, and wounds.
- Pulsed-field gel electrophoresis (PFGE) used for molecular typing of 43 GRE isolates.
Main Results:
- Forty-nine patients were colonized or infected, with ten experiencing infections including bacteraemia and peritonitis.
- Seven distinct GRE strains were identified within the first 7 months, with one strain predominating (17/43 isolates).
- Evidence suggested a potential single Manchester epidemic strain, with related isolates found in other hospitals.
Conclusions:
- The study highlights the emergence and spread of specific GRE strains within a renal unit.
- Molecular typing is crucial for understanding outbreak dynamics and guiding infection control measures.
- Inter-hospital transmission may contribute to the dissemination of GRE strains.