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Intensified Strategies to Control Vancomycin-Resistant Enterococci in Immunocompromised Patients

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Abstract

Increasing colonization and infection with vancomycin-resistant enterococci (VRE) in immunocompromised patients are associated with increased mortality. Despite contact precautions for VRE control, rapid limitation of its spread is often impossible. We report on a VRE outbreak in a hematologic/oncologic unit including 33 patients. Although 28 of the patients had only VRE colonization, VRE-related infection was probable in 4 patients, and VRE infection of the bloodstream occurred in 1 case. Two patients were identified by VRE screening on admission, 20 were identified by weekly routine VRE screening, and 6 were identified from specimens taken to clarify infections (eg, urine, bronchoalveolar lavage). Five individuals acquired VRE colonization as inpatients (contact patients). Multiple-locus variable-number tandem repeat analysis (MLVA) proved that the outbreak was caused byVanA gene-positiveEnterococcus faecium belonging to MLVA genogroup C1 (MLVA types 1,7,12). The outbreak strains exhibited the potential virulence factoresp (enterococcus surface protein). The outbreak was terminated within 2 months by intensified infection-control measures, including quarantine and the cohorting of patients who tested positive for VRE; however, VRE spread recurred after the measures were discontinued but was again limited by resuming the measures. We conclude that intensive infection-control strategies enable the timely termination of VRE outbreaks, even those involving VRE strains with high epidemic potential on “high-risk wards” (eg, hematologic/oncologic units). Premature discontinuation of infection-control measures may cause recurrence of the VRE spread.

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Authors and Affiliations

  1. Department of Hematology, Oncology and Transfusion Medicine, Universitätsmedizin Berlin, Charité -Campus Benjamin Franklin, Berlin, Germany

    M. Schmidt-Hieber, I. W. Blau, S. Schwartz, L. Uharek & E. Thiel

  2. Institute of Hygiene and Environmental Medicine, Universitätsmedizin Berlin, Charité -Campus Benjamin Franklin, Berlin, Germany

    K. Weist, T. Eckmanns, H. Rüden & C. Brandt

  3. Institute of Environmental Medicine and Hospital Hygiene, Freiburg, Germany

    D. Jonas

Authors
  1. M. Schmidt-Hieber
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  2. I. W. Blau
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  3. S. Schwartz
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  4. L. Uharek
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Correspondence to M. Schmidt-Hieber.

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Schmidt-Hieber, M., Blau, I.W., Schwartz, S. et al. Intensified Strategies to Control Vancomycin-Resistant Enterococci in Immunocompromised Patients. Int J Hematol 86, 158–162 (2007). https://doi.org/10.1532/IJH97.E0632

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  • DOI: https://doi.org/10.1532/IJH97.E0632

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