Uitbraak van vancomycineresistente Enterococcus faecium op een afdeling nefrologie

In April 2000, an outbreak of vancomycin-resistant Enterococcus faecium (VRE) was discovered in an internal medicine/nephrology and dialysis ward of the Eemland Hospital, Amersfoort, the Netherlands. Although enterococci are considered relatively non-virulent, VRE are resistant to almost all commercially available antibiotics. Surveillance cultures were obtained from all patients at the ward, all patients visiting the dialysis ward and the environment of patients. VRE were determined and clustering of strains was analysed using molecular genotyping. In all, 12 patients were colonized with the outbreak strain. Transmission of VRE usually occurs via the hands of health care workers. The ward was closed for new admissions, patients were divided in cohorts of colonized and non-colonized patients, and rooms were disinfected after patient discharge. Infection control measures (such as handwashing and use of gloves and gowns) were enforced and prescriptions of vancomycin and cephalosporins were reduced. With these measures the outbreak could be controlled. Epidemiological analysis demonstrated that earlier admission and previous use of ciprofloxacin, amoxicillin and amoxicillin-clavulanic acid were risk factors for colonization. A nearby hospital was a possible source of this outbreak.