在一所存在地方性vanB型耐万古霉素肠球菌（VRE）的医院里，出现了vanA型耐万古霉素屎肠球菌的暴发。

An outbreak of vanA vancomycin-resistant Enterococcus faecium in a hospital with endemic vanB VRE.

作者信息

Hughes Angus, Ballard Susan, Sullivan Sheena, Marshall Caroline

机构信息

University of Melbourne, School of Biomedical Sciences, Parkville, VIC 3010, Australia.

Microbiological Diagnostic Unit Public Health Laboratory (MDU PHL), Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia.

出版信息

Infect Dis Health. 2019 May;24(2):82-91. doi: 10.1016/j.idh.2018.12.002. Epub 2019 Jan 10.

DOI:10.1016/j.idh.2018.12.002

PMID:30638872

Abstract

BACKGROUND

In Australia, vanB vancomycin-resistant Enterococcus faecium (VREfm) has been endemic for over 20 years, but vanA VREfm isolates have rarely been reported.

METHODS

This outbreak report describes an outbreak of vanA VREfm in the intensive care unit (ICU) and cardiothoracic surgery (CTS) wards of a Melbourne hospital in 2015-2016. After the cluster was initially identified in the ICU ward, an active screening programme was implemented. VRE isolates were typed using in silico multi-locus sequence typing. In addition, to screening, enhanced environmental cleaning, chlorhexidine gluconate body washes, and standardisation of the surgical antibiotic prophylaxis regimen were implemented to control the outbreak.

RESULTS

There were 83 new isolates of vanA VREfm recovered from patients in the ICU (n = 31) and CTS (n = 52) wards. Screening identified 78 (94%) of cases. Three patients required treatment for clinical infection with vanA VREfm during the outbreak. The outbreak was polyclonal with 5 different multilocus sequence types carrying the vanA gene (ST17, ST80, ST203, ST252 and ST1421) detected from a subset of isolates (N = 43). The ST17 isolates all carried both the vanA and vanB gene. The intervention bundle resulted in control of the outbreak after 10 months.

CONCLUSION

Geographically, vanA VREfm has previously been uncommon in the region and this outbreak represents a change in local epidemiology. Few VRE outbreaks have been reported in CTS patients. The infection control responses controlled the outbreak within 10-months and may help guide future management of outbreaks.

摘要

背景

在澳大利亚，耐万古霉素屎肠球菌（VREfm）的vanB型已流行20多年，但vanA型VREfm分离株鲜有报道。

方法

本疫情报告描述了2015 - 2016年墨尔本一家医院重症监护病房（ICU）和心胸外科（CTS）病房发生的vanA VREfm疫情。在ICU病房最初发现聚集性病例后，实施了主动筛查计划。采用计算机多位点序列分型对VRE分离株进行分型。此外，除了筛查，还实施了强化环境清洁、葡萄糖酸氯己定全身清洗以及手术抗生素预防方案标准化等措施来控制疫情。

结果

从ICU病房（n = 31）和CTS病房（n = 52）的患者中分离出83株新的vanA VREfm菌株。筛查发现了78例（94%）病例。疫情期间有3例患者因临床感染vanA VREfm需要治疗。此次疫情是多克隆的，从部分分离株（N = 43）中检测到5种携带vanA基因的不同多位点序列类型（ST17、ST80、ST203、ST252和ST1421）。ST17分离株同时携带vanA和vanB基因。干预措施实施10个月后疫情得到控制。