Abstract
BackgroundEnterococcus faecium is ranked worldwide as one of the top ten pathogens identified in healthcare-associated infections (HAI) and is classified as one of the high priority pathogens for research and development of new antibiotics worldwide. Due to molecular biology techniques’ higher costs, the approach for identifying and controlling infectious diseases in developing countries has been based on clinical and epidemiological perspectives. Nevertheless, after an abrupt vancomycin-resistant Enterococcus faecium dissemination in the Méderi teaching hospital, ending up in an outbreak, further measures needed to be taken into consideration. The present study describes the vancomycin-resistant Enterococcus faecium pattern within Colombian’s largest installed-bed capacity hospital in 2016.MethodsThirty-three vancomycin-resistant Enterococcus faecium isolates were recovered during a 5-month period in 2016. Multilocus variable-number tandem-repeat analysis was used for molecular typing to determine clonality amongst strains. A modified time-place-sequence algorithm was used to trace VREfm spread patterns during the outbreak period and estimate transmission routes.ResultsFour clonal profiles were identified. Chronological clonal profile follow-up suggested a transitional spread from profile “A” to profile “B”, returning to a higher prevalence of “A” by the end of the study. Antibiotic susceptibility indicated high-level vancomycin-resistance in most isolates frequently matching vanA gene identification.DiscussionTransmission analysis suggested cross-contamination via healthcare workers. Despite epidemiological control of the outbreak, post-outbreak isolates were still being identified as having outbreak-related clonal profile (A), indicating reduction but not eradication of this clonality. This study supports the use of combined molecular and epidemiological strategies in an approach to controlling infectious diseases. It contributes towards a more accurate evaluation of the effectiveness of the epidemiological measures taken regarding outbreak control and estimates the main cause related to the spread of this microorganism.
Highlights
Enterococcus faecium is ranked worldwide as one of the top ten pathogens identified in healthcareassociated infections (HAI) and is classified as one of the high priority pathogens for research and development of new antibiotics worldwide
Enterococcus faecium (Efm) accounted for 3.7% of HAIs according to the summary of data reported to CDC’s national automated biosurveillance system regarding HAI-associated antimicrobial-resistant pathogens from 2011 to 2014 in the USA, a tendency which has been described in Colombia [10]
Thirty-three non-duplicated Vancomycin-resistant E. faecium (VREfm) isolates were recovered over a 5-month period (May to September 2016) from 29 inpatients and another 4 from environmental surfaces
Summary
Enterococcus faecium is ranked worldwide as one of the top ten pathogens identified in healthcareassociated infections (HAI) and is classified as one of the high priority pathogens for research and development of new antibiotics worldwide. Enterococcus faecium (Efm) has gained particular importance amongst healthcare-associated infections (HAIs) due to its presence worldwide and ability to persist for long periods in healthcare-related settings [4,5,6]. Is ranked as the fifth most frequently-identified HAI-related pathogen [3, 9]. It is an ESKAPE bacteria, i.e. those which “escape” from most currently available antibiotics. Efm accounted for 3.7% of HAIs according to the summary of data reported to CDC’s national automated biosurveillance system regarding HAI-associated antimicrobial-resistant pathogens from 2011 to 2014 in the USA, a tendency which has been described in Colombia [10]
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