Abstract
Vancomycin-resistant enterococci (VRE) have emerged in many parts of the world, but have only been reported sporadically in Hong Kong. We report an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) in a neurosurgical unit at a tertiary teaching hospital between 3 March and 3 April 2009 in Hong Kong. During the outbreak investigation, clinical samples from 193 (91.5%) of 211 patients who had stayed in the neurosurgical unit and 506 environmental samples were screened for VREfm. Besides the index case, another 3 (1.6%) out of 192 patients were found to be positive for VREfm. Two (0.4%) out of 506 environmental samples were positive for VREfm. All four clinical and two environmental isolates were found to be clonally related by pulse-field gel electrophoresis. The risk factors for nosocomial acquisition of VREfm included advanced age (P=0.047), presence of nasogastric tubing (P=0.002) and tracheostomy (P<0.001), and the use of β-lactam antibiotics (P<0.001) and vancomycin (P=0.001). Contrary to other VRE outbreaks in which the spread was rapid, the neurosurgical patients’ immobilization because of coma and mechanical ventilation dependency, and the vigilant practice of hand hygiene by health-care workers successfully limited the number of secondary cases despite the delayed recognition of the index case. All patients with VREfm were labeled in the hospital network information system so that stringent infection control measures with contact precautions would be carried out once these patients were readmitted to prevent its spread in our locality.
Highlights
Since the initial reports of vancomycin-resistant enterococci (VRE) in France and the United Kingdom in 1986,1,2 VRE have spread throughout the world and have become a major cause of nosocomial infections
Epidemiological investigation On 28 March 2009, vancomycin-resistant E. faecium (VREfm) was isolated from the catheterized urine in a 77-year-old man hospitalized in the neurosurgical unit of hospital A since 5 March 2009
The VREfm was isolated from the stool of another 89-year-old man who was transferred to hospital B on 16 March 2009
Summary
Since the initial reports of vancomycin-resistant enterococci (VRE) in France and the United Kingdom in 1986,1,2 VRE have spread throughout the world and have become a major cause of nosocomial infections. During the 1990s, a significant increase of VRE was observed in the United States from 0.3% in 1989 to over 28% of all isolates in 2004.3,4 Recently, VRE have emerged in Asian countries such as Singapore, Japan, Korea, and China[5,6,7,8,9] but have seldom been reported in Hong Kong. Extensive investigation of the source, contact tracing of the potential secondary cases, and environmental surveillance were performed to control the spread of VREfm in a non-endemic area
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