Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, Switzerland, 2017 to 2020

Abstract

A large clonal outbreak caused by vancomycin-resistant Enterococcus faecium (VRE) affected the Bern University Hospital group from the end of December 2017 until July 2020. We describe the characteristics of the outbreak and the bundle of infection prevention and control (IPC) measures implemented. The outbreak was first recognised when two concomitant cases of VRE bloodstream infection were identified on the oncology ward. During 32 months, 518 patients in the 1,300-bed hospital group were identified as vanB VRE carriers. Eighteen (3.5%) patients developed an invasive infection, of whom seven had bacteraemia. In 2018, a subset of 328 isolates were analysed by whole genome sequencing, 312 of which were identified as sequence type (ST) 796. The initial IPC measures were implemented with a focus on the affected wards. However, in June 2018, ST796 caused another increase in cases, and the management strategy was intensified and escalated to a hospital-wide level. The clinical impact of this large nosocomial VRE outbreak with the emergent clone ST796 was modest. A hospital-wide approach with a multimodal IPC bundle was successful against this highly transmissible strain.

Description of an Enterococcus faecium genotype vanB outbreak in a hospitalization ward

“…These results do not correspond to what was observed in our study, where only one patient required antibiotic treatment with a favorable evolution. This low clinical impact coincides with what has been described in other outbreaks [4,7,12]. The fact that the outbreak happened in a conventional ward where there are no severely immunosuppressed patients could have contributed to this low impact.…”

Occurrence of bone sialoprotein-binding protein gene among clinical vancomycin-resistant Enterococcus faecium isolated from bone infections

“…As vancomycin is the last choice of drugs for these microbes, which implies that antibacterial treatment options for infectious diseases caused by Enteroccocus spp. are restricted [17].…”

“…Because of hematogenous fabric intrusion, clinical Osteomyelitis and bone infections caused by VRE harboring bbp gene can inhibit the efficiency of survival and make concessions to bone healing level. Insufficiency to control raises the cost of healthcare because it necessitates a longer hospital stay for diagnosis, wide-ranging antibacterial drugs management, and, in certain contexts, medical intervention [16,17]. Even though serious tensions regarding E. faecium harmfulness in chronic wounds, there seems to be a paucity of data on their occurrence in osteomyelitis on this subject, especially in Iraq.…”

Extending outbreak investigation with machine learning and graph theory: Benefits of new tools with application to a nosocomial outbreak of a multidrug-resistant organism

“…An upcoming publication describes the outbreak and procedures in more detail. 20 In addition, we assembled diverse data from electronic medical records generated during the first 2 years of the outbreak (January 1, 2018-December 31, 2019), covering different aspects of medical care (Table 1). For comparisons, we labeled all patients (including children) with VRE acquisition during the outbreak period as VRE-positive (cases), and all other patients, whether tested or not, were assumed to be VRE negative (controls).…”