Abstract
The total number of persons infected or colonised with vancomycin-resistant enterococci mandatorily reported to the Swedish Institute for Infectious Disease Control increased dramatically during 2007 and 2008. During a period of twenty months from 1 July 2007 to 28 February 2009, a total of 760 cases were reported compared with 194 cases reported during the entire period from 2000 to 2006. This rise was mainly attributed to a wide dissemination of vancomycin resistant enterococci which started in a number of hospitals in Stockholm in the autumn of 2007 and was followed by dissemination in various healthcare facilities (hospitals and homes for the elderly) in a further two Swedish counties in 2008. The majority of the cases (97%) were acquired in Sweden and among these, healthcare-acquired E. faecium vanB dominated (n=634). The majority of these isolates had identical or closely related pulsed-field gel electrophoresis patterns indicating clonal dissemination in the affected counties. The median minimum inhibitory concentration of vancomycin was 32 mg/L (ranging from 4 to >128 mg/L) and of teichoplanin 0.12 mg/L (ranging from 0.06 to 0.25 mg/L). Particular emphasis was placed on countermeasures such as screening, contact tracing, cleaning procedures, education in accurate use of infection control practices as well as increasing awareness of hygiene among patients and visitors. With these measures the dissemination rate decreased substantially, but new infections with the E. faecium vanB strain were still detected.
Highlights
Enterococci may acquire various types of glycopeptide antibiotic resistance via van-associated genetic elements, of which vanA and vanB are the most prevalent in clinically relevant species [1,2]
Vancomycin-resistant E. faecium and E. faecalis became mandatorily notifiable according to the Swedish Communicable Diseases Act in January 2000, and in 2004 an amendment concerning mandatory contact tracing was added
The majority of the persons (n=738, 97.1%) had acquired VRE in Sweden. These 738 domestic cases were notified from 10 counties, and E. faecium vanB was the most commonly reported strain (n=634, 85.9%). (Figure 1 and Table)
Summary
Enterococci may acquire various types of glycopeptide antibiotic resistance via van-associated genetic elements (vanA/B/D/E/G/L), of which vanA and vanB are the most prevalent in clinically relevant species [1,2]. The prevalence of VRE among invasive E. faecium blood isolates in Sweden as reported to the European antimicrobial resistance surveillance system (EARSS; data representing more than 75% of the population) was generally less than 1% for most of the period from 2001 to 2006 [8]. This prevalence is clearly lower than reported from some other European countries [8,9]
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