Molecular epidemiology of vancomycin-resistant enterococci: A two-year perspective

V. Stosor*, J. Krusczynski, T. Suriano, G. A. Noskin, L. R. Peterson

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

As problems with VRE persist in many institutions, infection control measures are essential in limiting the spread of this pathogen. An important facet of our comprehensive infection control program includes routine molecular typing of this organism to determine the extent of clonal dissemination. We retrospectively examined the molecular epidemiology of VRE over a two year period to determine patterns of transmission. Patients (pts) on high risk units, are routinely screened for rectal colonization. Molecular strain typing of all surveillance plus clinical isolates is performed by restriction endonuclease digestion with HindIII. From Jan 1995 through Dec 1996, 389 VRE isolates from 199 pts were identified resulting in 33 distinct clonal genotypes. Of these, 15 were involved in 28 occurrences of nosocomial transmission, confirmed by comparing genotypic patterns and tracking pt movement throughout our hospital and the neighboring rehabilitation facility. While three major outbreaks (involving 25, 20, and 16 pts) were identified, the remaining episodes of nosocomial transmission occurred in "mini-outbreaks," during which a particular strain was transmitted from one pt to a limited number of other pts. For these mini-outbreaks, there was one instance of transmission from 1 pt to 6 other pts, 2 occurrences from 1 to 4 other pts, 3 instances of transmission from 1 to 3 other pts, 7 instances from 1 to 2 other pts and, 12 instances of transmission from 1 to 1 additional pt. In an institution where VRE are prevalent, routinely-employed molecular typing can be a powerful tool in identifying small and large clusters of VRE that may otherwise escape detection. Within our medical center, unique VRE strains commonly disseminate to a limited number of pts before the outbreak is identified and appropriate barrier precautions are instituted. More rapid identification of VRE carriers may minimize or eliminate this type of transmission.

Original languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - Dec 1 1997

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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