Abstract
BackgroundPrevalence of vancomycin-resistant enterococci has increased in Germany. Here, we report the cluster of linezolid- and vancomycin-resistant Enterococcus faecium (LVRE) in a German department for hematologic stem cell transplantation (HSCT).MethodsIn this retrospective analysis we included all patients with LVRE in a university-based department for HSCT in 2014 and 2015. Patients chart reviews were used to investigate the epidemiology and clinical outcome. Available LVRE isolates underwent detailed microbiological characterization and genotyping by pulsed-field gel electrophoresis (PFGE).ResultsIn total, 20 patients with LVRE were identified within the observed time period. All except two patients underwent allogeneic HSCT. Surveillance culture results from incoming patients and chart review revealed that 10 of 20 patients were colonized at hospital admission. Eight of 10 patients with in-hospital acquired LVRE had previous linezolid treatment. Analysis of spatio-temporal patterns showed no evidence for LVRE patient-to-patient or environment-to-patient transmission within the HSCT department. In five cases (25 %) LVRE bloodstream infection occurred. Nine LVRE isolates could be saved for characterization. Eight isolates carried vanA, one isolate vanB. PFGE analysis showed that four different LVRE clones were responsible for the cluster. One single genotype was present in six LVRE isolates whereupon the corresponding patients were all referred from the same hospital to the HSCT department.ConclusionsThis is the first report demonstrating the emergence of LVRE in a German HSCT department. (L)VRE screening at patients’ admission and appropriate infection control strategies were sufficient to prevent any transmission. Further studies in this predisposed patient collective are warranted.
Highlights
Prevalence of vancomycin-resistant enterococci has increased in Germany
In two of the five cases (40 %) the linezolid- and vancomycin-resistant Enterococcus faecium (LVRE) bacteremia was associated with death of the patient
In the other 15 cases, LVRE was predominantly found in the gut or in the urinary tract
Summary
Prevalence of vancomycin-resistant enterococci has increased in Germany. We report the cluster of linezolid- and vancomycin-resistant Enterococcus faecium (LVRE) in a German department for hematologic stem cell transplantation (HSCT). Data from 2014 of the European Antimicrobial Resistance Surveillance Network (EARS-Net) reported the proportion of vancomycin resistance in Enterococcus faecium in Europe being 8.9 % [1]. The VRE rate in Germany has increased dramatically in the last years [2]: Between 2007. Infections with VRE are a major cause of morbidity in HSCT recipients [3]. Krull et al Antimicrobial Resistance and Infection Control (2016) 5:31 described from US, Greece, Italy and Ireland mainly in intensive care unit patients, patients after solid organ transplantation or with hematological malignancy [5–10]. Linezolid exposure and patient-to-patient transmission were shown to be main factors for LVRE infection [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
