097 Unexpected detection of VRE as a consequence of enhanced CRE screening

Abstract

Background Great Ormond Street Hospital is a tertiary paediatric centre with 2 68 000 patient visits per year from a global patient demographic. Within paediatric patients, infection with Vancomycin Resistant Enterococci (VRE) has always been uncommon. Detection of colonisation of patients with VRE has also been considered to be uncommon with only 26 cases over the last 3 years. In 2015 the laboratory-modified screening protocol for admission stools to enable enhanced screening for Carbapenemase Resistant Enterobacteriaceae (CRE) to include the use of CARBA SMART agar (Biomerieux). It was noticed by laboratory staff that enterococci were coming through and because of interest in January 2017 an isolate was followed up and shown to be a VRE. Further enterococcal growths were investigated. Aim To investigate whether VRE detected in these patients represents higher than expected ‘out-of-GOSH’ colonisation or arose from an unrecognised hospital outbreak Method 1500 stools screened. 30 patients have now been shown to be positive for VRE over 3 month period, and 20 isolates have been referred for typing by Pulse Field Gel Electrophoresis (PFGE). Results 3 of the patient isolates from haematology/oncology ward were linked by PFGE analysis, and 2 further cases were determined to be linked on a cardiac ward. Epidemiological investigation showed a possible link. The remaining 15 were demonstrated to have unique PFGE profiles and were not considered to be linked to possible transmission events at GOSH. Conclusion Intellectual curiosity demonstrated that modification of CRE screening methodologies could be used for detection of VRE Levels of colonisation within paediatric patient populations are higher than previously thought Systematic screening with specific detection methodologies (CARBA SMART is not designed for this purpose) may be needed to investigate the level of VRE colonisation in children attending the paediatric tertiary centre for infection prevention control and empirical antibiotic policy developments.