Outbreak of vancomycin-resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic

Br J Haematol. 2002 Mar;116(4):826-33. doi: 10.1046/j.0007-1048.2002.03339.x.


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.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Bacteremia
  • Case-Control Studies
  • Cross Infection*
  • Drug Therapy, Combination / therapeutic use
  • Enterococcus faecium*
  • Female
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / transmission*
  • Hematology*
  • Hospital Departments*
  • Humans
  • Infection Control
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Isolation
  • Risk Assessment
  • Serum Albumin / analysis
  • Vancomycin Resistance*
  • Virginiamycin / therapeutic use


  • Anti-Bacterial Agents
  • Serum Albumin
  • Virginiamycin
  • quinupristin-dalfopristin