A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit

Infect Control Hosp Epidemiol. 1992 Apr;13(4):195-200. doi: 10.1086/646509.

Abstract

Objective: To describe the epidemiology of a cluster of vancomycin-resistant Enterococcus faecium (VAREC) in a cardiothoracic surgery intensive care unit.

Design: A case series of patients identified through review of surveillance data on nosocomial infections, review of microbiologic records, and culture survey of patients in the unit.

Results: Six patients in the cardiothoracic surgery intensive care unit had VAREC with identical antimicrobic susceptibility patterns over a 6-month period. Four patients were identified with VAREC through prospective surveillance and 2 through retrospective review. Prior vancomycin use was seen more commonly in patients with VAREC (6/6, 100%) than in those without VAREC (3/12, 25%) (Fisher's exact test, p = .01). Six of the 7 patients with prior infection developed VAREC (85.7%). A prior nosocomial infection and prior exposure to vancomycin were found to be important variables in a logistic regression analysis. VAREC also was isolated from the environment. A combination of cohorting of patients and staff, and modifications of standard contact isolation practices eliminated the presence of VAREC from the cardiothoracic surgery intensive care unit.

Conclusions: The results suggest that prior administration of vancomycin, especially in the patient who develops nosocomial infection, can influence the acquisition of vancomycin-resistant enterococci and that VAREC may be transmitted from patient to patient. Using a modification of the standard infection control practice of isolation, we were able to control the spread of this resistant strain of E faecium.

MeSH terms

  • Cross Infection / microbiology
  • Cross Infection / prevention & control
  • Cross Infection / transmission*
  • Disease Outbreaks*
  • Drug Resistance, Microbial
  • Enterococcus faecium / drug effects*
  • Enterococcus faecium / isolation & purification
  • Gram-Positive Bacterial Infections / microbiology
  • Gram-Positive Bacterial Infections / prevention & control
  • Gram-Positive Bacterial Infections / transmission*
  • Hospital Bed Capacity, 300 to 499
  • Humans
  • Infection Control
  • Intensive Care Units*
  • Microbial Sensitivity Tests
  • New York City / epidemiology
  • Population Surveillance
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Vancomycin / administration & dosage
  • Vancomycin / pharmacology*

Substances

  • Vancomycin