Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein and Utrecht, The Netherlands; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein and Utrecht, The Netherlands.
J Hosp Infect. 2018 Dec;100(4):e216-e225. doi: 10.1016/j.jhin.2018.02.016. Epub 2018 Feb 21.
A large outbreak of three epidemic vancomycin-resistant Enterococcus faecium (VRE) clones affected the study hospital for almost two years.
To describe the strategy to successfully control this outbreak and eradicate VRE from the study hospital.
Infection control interventions started after detection of VRE in three patients. Hospital-wide surveillance was started after ongoing transmission despite isolation precautions, cleaning and contact tracing. Hygiene education and discipline were enhanced. Despite these interventions, additional measures were required to control the outbreak, such as ward disinfection with hydrogen peroxide vapour and the introduction of a VRE quarantine ward. Ultimately, ciprofloxacin prophylaxis for haematological patients on chemotherapy was abandoned.
Over a 22-month period, 242 VRE carriers were identified. Of these, 128 (53%) patients were detected by hospital-wide surveillance alone. Three epidemic clones were detected: ST494-vanA (N = 160), ST78-vanA (N = 23) and ST117-vanB (N = 32). In total, 5614 possible contacts were identified. VRE transmission occurred on 13 out of 23 wards. VRE was cultured from clinical specimens in 22 patients (seven with bacteraemia). Since January 2014, no further transmission of these VRE clones has been observed.
Infection control measures according to international guidelines were insufficient to expose the outbreak to its full extent and control it. Its full extent only became apparent after sustained hospital-wide screening. Successful control of this hospital-wide VRE outbreak was feasible, but required great effort. Final containment and eradication of the epidemic clones was achieved by environmental decontamination with hydrogen peroxide vapour, strict isolation precautions, a VRE quarantine ward and antimicrobial stewardship.
大规模爆发三种流行的万古霉素耐药粪肠球菌（VRE）克隆株，影响研究医院将近两年。
描述成功控制此次暴发并从研究医院根除 VRE 的策略。
在发现 3 例 VRE 患者后开始感染控制干预措施。尽管采取了隔离预防措施、清洁和接触追踪，但由于持续传播，开始进行全院监测。加强了卫生教育和纪律。尽管采取了这些干预措施，但仍需要采取额外措施来控制暴发，例如用过氧化氢蒸气对病房进行消毒以及引入 VRE 隔离病房。最终，放弃了对接受化疗的血液科患者使用环丙沙星预防。
在 22 个月的时间里，共发现 242 例 VRE 携带者。其中，仅通过全院监测发现 128 例（53%）患者。检测到三种流行克隆株：ST494-vanA（N=160）、ST78-vanA（N=23）和 ST117-vanB（N=32）。总共确定了 5614 名可能的接触者。在 23 个病房中的 13 个病房发生了 VRE 传播。22 例患者的临床标本培养出 VRE（7 例血培养阳性）。自 2014 年 1 月以来，未再观察到这些 VRE 克隆株的进一步传播。
根据国际指南采取的感染控制措施不足以充分暴露暴发并加以控制。只有持续进行全院筛查后，才充分了解其全貌。通过过氧化氢蒸气环境消毒、严格的隔离预防措施、VRE 隔离病房和抗菌药物管理，成功控制了此次医院范围的 VRE 暴发是可行的，但需要付出巨大努力。最终通过环境去污、严格隔离、建立 VRE 隔离病房和抗菌药物管理实现了对流行克隆株的最终遏制和根除。
