Abstract
BackgroundCurrently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples.MethodsFive VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST).ResultsWGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies.ConclusionsOur results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.
Highlights
In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was discovered in Wuhan City, China and rapidly developed into a pandemic that poses a serious threat to health care systems worldwide [1,2,3]
One concern among the infection prevention community is that the COVID-19 pandemic will cause “collateral damage” to long-established infection control measures including the prevention of healthcareassociated infections [8]. It remains unknown if the present diversion of hospital resources and changes in infection control practices will translate into an increase of nosocomial transmissions, in particular of Kampmeier et al Antimicrobial Resistance and Infection Control (2020) 9:154 multidrug resistant organisms (MDRO), during the COVID-19 pandemic or if the increased efforts to improve infection control measures will have a positive effect on nosocomial MDRO transmissions [9, 10]
In April 2020, vancomycin-resistant enterococci (VRE) from clinically relevant samples were detected in three patients from both intensive care unit (ICU) subunits. As this rate exceeded the baseline of three VRE infections per year on this ward, an outbreak investigation was initiated and – in accordance to the German guideline published in 2018 - a bundle strategy for terminating VRE transmission was implemented [16]. This bundle comprised a point prevalence screening among all patients, a VRE screening on admission and once a week for every patient, environmental sampling to detect VRE contamination of patient surroundings, contact precautions including the use of protective equipment (PPE) and patient isolation
Summary
In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was discovered in Wuhan City, China and rapidly developed into a pandemic that poses a serious threat to health care systems worldwide [1,2,3]. We describe a nosocomial cluster of VRE that involved three COVID-19 patients as well as two SARS-CoV-2 negative ICU patients. Hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. We report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples
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