Outbreak of vancomycin‐resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic
We describe an outbreak of vancomycin‐resistant Enterococcus faecium (VRE) on the haematology ward of a Dutch university hospital. After the occurrence of three consecutive cases of bacteraemia with VRE, strains were genotyped and found to be identical. During the next 4 months an intensive surveill...
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| Veröffentlicht in: | British journal of haematology 2002-03, Vol.116 (4), p.826-833 |
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| container_title | British journal of haematology |
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| creator | Timmers, Gert Jan Van Der Zwet, Wil C. Simoons‐Smit, Ina M. Savelkoul, Paul H. M. Meester, Helena H. M. Vandenbroucke‐Grauls, Christina M. J. E. Huijgens, Peter C. |
| description | We describe an outbreak of vancomycin‐resistant Enterococcus faecium (VRE) on the haematology ward of a Dutch university hospital. After the occurrence of three consecutive cases of bacteraemia with VRE, strains were genotyped and found to be identical. During the next 4 months an intensive surveillance programme identified 21 additional patients to be colonized with VRE, while two more patients developed bacteraemia. A case–control study was carried out to identify risk factors for VRE acquisition. In comparison with VRE‐negative control patients (n=49), cases (n=24) had a longer stay on the ward during the year preceding the outbreak (25·8 versus 10·1 d, P=0·02), more cases with acute myeloid leukaemia [11 versus 4, odds ratio (OR) 9·5, 95% confidence interval (CI95) 2·4–32·2] and higher grades of mucositis (P=0·03). Logistic regression analysis identified antibiotic use within 1 month before admission (OR 13·0, CI95 2·1–80·5, P=0·006) and low albumin levels at baseline (OR 1·2, CI95 1·1–1·3, P=0·02) to be independent risk factors. Four patients with VRE‐bacteraemia were successfully treated with quinupristin/dalfopristin (Synercid®). Control of the outbreak was achieved by step‐wise implementation of intensive infection control measures, which included the cohorting of patients, allocation of nurses and reinforcement of hand hygiene. |
| doi_str_mv | 10.1046/j.0007-1048.2002.03339.x |
| format | Article |
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M. ; Meester, Helena H. M. ; Vandenbroucke‐Grauls, Christina M. J. E. ; Huijgens, Peter C.</creator><creatorcontrib>Timmers, Gert Jan ; Van Der Zwet, Wil C. ; Simoons‐Smit, Ina M. ; Savelkoul, Paul H. M. ; Meester, Helena H. M. ; Vandenbroucke‐Grauls, Christina M. J. E. ; Huijgens, Peter C.</creatorcontrib><description>We describe an outbreak of vancomycin‐resistant Enterococcus faecium (VRE) on the haematology ward of a Dutch university hospital. After the occurrence of three consecutive cases of bacteraemia with VRE, strains were genotyped and found to be identical. During the next 4 months an intensive surveillance programme identified 21 additional patients to be colonized with VRE, while two more patients developed bacteraemia. A case–control study was carried out to identify risk factors for VRE acquisition. In comparison with VRE‐negative control patients (n=49), cases (n=24) had a longer stay on the ward during the year preceding the outbreak (25·8 versus 10·1 d, P=0·02), more cases with acute myeloid leukaemia [11 versus 4, odds ratio (OR) 9·5, 95% confidence interval (CI95) 2·4–32·2] and higher grades of mucositis (P=0·03). Logistic regression analysis identified antibiotic use within 1 month before admission (OR 13·0, CI95 2·1–80·5, P=0·006) and low albumin levels at baseline (OR 1·2, CI95 1·1–1·3, P=0·02) to be independent risk factors. Four patients with VRE‐bacteraemia were successfully treated with quinupristin/dalfopristin (Synercid®). Control of the outbreak was achieved by step‐wise implementation of intensive infection control measures, which included the cohorting of patients, allocation of nurses and reinforcement of hand hygiene.</description><identifier>ISSN: 0007-1048</identifier><identifier>EISSN: 1365-2141</identifier><identifier>DOI: 10.1046/j.0007-1048.2002.03339.x</identifier><identifier>PMID: 11886387</identifier><identifier>CODEN: BJHEAL</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science, Ltd</publisher><subject>Adult ; Anti-Bacterial Agents - administration & dosage ; Bacteremia ; Biological and medical sciences ; Case-Control Studies ; Cross Infection ; Drug Therapy, Combination - therapeutic use ; Enterococcus faecium ; Epidemiology. Vaccinations ; Female ; General aspects ; Gram-Positive Bacterial Infections - drug therapy ; Gram-Positive Bacterial Infections - transmission ; haematology ; Hematology ; Hospital Departments ; Humans ; Infection Control ; Infectious diseases ; Length of Stay ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; nosocomial outbreak ; Patient Isolation ; Risk Assessment ; risk factors ; Serum Albumin - analysis ; Vancomycin Resistance ; vancomycin‐resistant Enterococcus ; Virginiamycin - therapeutic use</subject><ispartof>British journal of haematology, 2002-03, Vol.116 (4), p.826-833</ispartof><rights>2002 INIST-CNRS</rights><rights>Copyright Blackwell Scientific Publications Ltd. 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M.</creatorcontrib><creatorcontrib>Meester, Helena H. M.</creatorcontrib><creatorcontrib>Vandenbroucke‐Grauls, Christina M. J. E.</creatorcontrib><creatorcontrib>Huijgens, Peter C.</creatorcontrib><title>Outbreak of vancomycin‐resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic</title><title>British journal of haematology</title><addtitle>Br J Haematol</addtitle><description>We describe an outbreak of vancomycin‐resistant Enterococcus faecium (VRE) on the haematology ward of a Dutch university hospital. After the occurrence of three consecutive cases of bacteraemia with VRE, strains were genotyped and found to be identical. During the next 4 months an intensive surveillance programme identified 21 additional patients to be colonized with VRE, while two more patients developed bacteraemia. A case–control study was carried out to identify risk factors for VRE acquisition. In comparison with VRE‐negative control patients (n=49), cases (n=24) had a longer stay on the ward during the year preceding the outbreak (25·8 versus 10·1 d, P=0·02), more cases with acute myeloid leukaemia [11 versus 4, odds ratio (OR) 9·5, 95% confidence interval (CI95) 2·4–32·2] and higher grades of mucositis (P=0·03). Logistic regression analysis identified antibiotic use within 1 month before admission (OR 13·0, CI95 2·1–80·5, P=0·006) and low albumin levels at baseline (OR 1·2, CI95 1·1–1·3, P=0·02) to be independent risk factors. Four patients with VRE‐bacteraemia were successfully treated with quinupristin/dalfopristin (Synercid®). Control of the outbreak was achieved by step‐wise implementation of intensive infection control measures, which included the cohorting of patients, allocation of nurses and reinforcement of hand hygiene.</description><subject>Adult</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Bacteremia</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Cross Infection</subject><subject>Drug Therapy, Combination - therapeutic use</subject><subject>Enterococcus faecium</subject><subject>Epidemiology. Vaccinations</subject><subject>Female</subject><subject>General aspects</subject><subject>Gram-Positive Bacterial Infections - drug therapy</subject><subject>Gram-Positive Bacterial Infections - transmission</subject><subject>haematology</subject><subject>Hematology</subject><subject>Hospital Departments</subject><subject>Humans</subject><subject>Infection Control</subject><subject>Infectious diseases</subject><subject>Length of Stay</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>nosocomial outbreak</subject><subject>Patient Isolation</subject><subject>Risk Assessment</subject><subject>risk factors</subject><subject>Serum Albumin - analysis</subject><subject>Vancomycin Resistance</subject><subject>vancomycin‐resistant Enterococcus</subject><subject>Virginiamycin - therapeutic use</subject><issn>0007-1048</issn><issn>1365-2141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc9u1DAQhy0EosvCKyALCW4b7DjOHyQOpSoUVKkXOFsTZ0y9TezFdqB74wE48Iw8CQ67ohInTh5L3_w8448QylnBWVW_3BaMsWaT67YoGSsLJoToitt7ZMVFLTclr_h9svoLnZBHMW4Z44JJ_pCccN62tWibFflxNac-INxQb-hXcNpPe23dr-8_A0YbE7hEz13C4LXXeo7UAGo7T9Q6CvQacILkR_95T2dn0ysabLzJjE4-UIgRY5wwR4AbaJy1znczj1R7l4IflzfTNVLc2QEnqx-TBwbGiE-O55p8env-8exic3n17v3Z6eVGV5J3mxaroW1BwyBQm7qCRgIaEEPJpBi06QFrgLLjPUioOe_KvLhgvTBN_oBaijV5ccjdBf9lxpjUZKPGcQSHfo6q4ZKJKsNr8uwfcOvn4PJsindtzWpWLmntAdLBxxjQqF2wE4S94kwtutRWLSaWulWLLvVHl7rNrU-P-XM_4XDXePSTgedHAKKG0YRsyMY7TjSN7GSZudcH7psdcf_fA6g3Hy6WSvwGBQi0Lw</recordid><startdate>200203</startdate><enddate>200203</enddate><creator>Timmers, Gert Jan</creator><creator>Van Der Zwet, Wil C.</creator><creator>Simoons‐Smit, Ina M.</creator><creator>Savelkoul, Paul H. M.</creator><creator>Meester, Helena H. M.</creator><creator>Vandenbroucke‐Grauls, Christina M. J. E.</creator><creator>Huijgens, Peter C.</creator><general>Blackwell Science, Ltd</general><general>Blackwell</general><general>Blackwell Publishing Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>200203</creationdate><title>Outbreak of vancomycin‐resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic</title><author>Timmers, Gert Jan ; Van Der Zwet, Wil C. ; Simoons‐Smit, Ina M. ; Savelkoul, Paul H. M. ; Meester, Helena H. M. ; Vandenbroucke‐Grauls, Christina M. J. 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E.</au><au>Huijgens, Peter C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outbreak of vancomycin‐resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic</atitle><jtitle>British journal of haematology</jtitle><addtitle>Br J Haematol</addtitle><date>2002-03</date><risdate>2002</risdate><volume>116</volume><issue>4</issue><spage>826</spage><epage>833</epage><pages>826-833</pages><issn>0007-1048</issn><eissn>1365-2141</eissn><coden>BJHEAL</coden><abstract>We describe an outbreak of vancomycin‐resistant Enterococcus faecium (VRE) on the haematology ward of a Dutch university hospital. After the occurrence of three consecutive cases of bacteraemia with VRE, strains were genotyped and found to be identical. During the next 4 months an intensive surveillance programme identified 21 additional patients to be colonized with VRE, while two more patients developed bacteraemia. A case–control study was carried out to identify risk factors for VRE acquisition. In comparison with VRE‐negative control patients (n=49), cases (n=24) had a longer stay on the ward during the year preceding the outbreak (25·8 versus 10·1 d, P=0·02), more cases with acute myeloid leukaemia [11 versus 4, odds ratio (OR) 9·5, 95% confidence interval (CI95) 2·4–32·2] and higher grades of mucositis (P=0·03). Logistic regression analysis identified antibiotic use within 1 month before admission (OR 13·0, CI95 2·1–80·5, P=0·006) and low albumin levels at baseline (OR 1·2, CI95 1·1–1·3, P=0·02) to be independent risk factors. Four patients with VRE‐bacteraemia were successfully treated with quinupristin/dalfopristin (Synercid®). Control of the outbreak was achieved by step‐wise implementation of intensive infection control measures, which included the cohorting of patients, allocation of nurses and reinforcement of hand hygiene.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science, Ltd</pub><pmid>11886387</pmid><doi>10.1046/j.0007-1048.2002.03339.x</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Anti-Bacterial Agents - administration & dosage Bacteremia Biological and medical sciences Case-Control Studies Cross Infection Drug Therapy, Combination - therapeutic use Enterococcus faecium Epidemiology. Vaccinations Female General aspects Gram-Positive Bacterial Infections - drug therapy Gram-Positive Bacterial Infections - transmission haematology Hematology Hospital Departments Humans Infection Control Infectious diseases Length of Stay Logistic Models Male Medical sciences Middle Aged nosocomial outbreak Patient Isolation Risk Assessment risk factors Serum Albumin - analysis Vancomycin Resistance vancomycin‐resistant Enterococcus Virginiamycin - therapeutic use |
| title | Outbreak of vancomycin‐resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic |
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