Outbreaks caused by vancomycin-resistant Enterococcus faecium in hematology and oncology departments: A systematic review

Abstract

BackgroundVancomycin-resistance in Enterococcus faecium (VRE) poses a major threat in health care settings. It is well known that patients in hematology and oncology departments are especially at risk of nosocomial VRE acquisition. This systematic review of the literature provides data on the main sources, transmission modes and potential risk factors for VRE acquisition as well as appropriate infection control measures in order to terminate such nosocomial outbreaks.MethodsData on nosocomial VRE outbreaks on hematology and oncology wards was retrieved from the Outbreak Database and PubMed.ResultsA total of 35 VRE outbreaks describing 757 affected patients and 77 deaths were included in this review. The most frequent site of pathogen detection were stool samples or rectal swabs (57% of all isolation sites), followed by blood cultures (30%). The most common outbreak source was an index patient. The main modes of transmission were 1) hands of health care workers, 2) contact to a contaminated environment and 3) patient-to-patient contact. The most common risk factor for VRE positivity was prior antibiotic treatment. The most common infection control measures performed were screening and isolating or cohorting of patients.ConclusionA rational use of antibiotics in hematology and oncology units is recommended in order to reduce selection pressure on resistant pathogens such as VRE. In addition the importance of hand hygiene should be stressed to all staff whenever possible.

Expansion of Vancomycin-Resistant Enterococcus faecium in an Academic Tertiary Hospital in Southwest Germany: a Large-Scale Whole-Genome-Based Outbreak Investigation

“…Likewise, only limited data are available regarding the impact of different transmission routes for VREfm in the hospital setting. A recent systematic review described the major transmission routes as being the hands of health care workers, the contamination of the environment, and patient-to-patient transmission (23). In order to account for all these modes in our study, we established an epidemiological contact intensity score to quantify the possibility of transmission of a clone between two patients.…”

Comprehensive integrated NGS-based surveillance and contact-network modeling unravels transmission dynamics of vancomycin-resistant enterococci in a high-risk population within a tertiary care hospital

“…In these patients, impairments of the gut microbiome by frequent antibiotic treatment may result in an "overgrowth" of VRE, hence leading to an increased risk for enterococcal (VRE) bloodstream infections [21][22][23][24]. Contaminated patient rooms, healthcare workers, as well as contact between patients are of particular importance for transmitting VRE within a hospital [10,[25][26][27][28]. More recent studies highlighted the advantages of using data-driven approaches to measure the effects of contact monitoring in order to reveal pathogen spread in hospitals, further using these data to assess infection control and prevention strategies [29,30].…”

Retrospective Evaluation of Vancomycin Resistant Enterococci Outbreak in Neonatal Intensıve Care Unit

“…Cases of VRE are reported by the microbiology department to the ICC. The ICC takes measures such as patient monitoring, isolation, cohorting, environmental monitoring, disinfection, sterilization, personal protective equipment, hand hygiene, healthcare personnel training and monitoring, antibiotic changes, inspection of equipment and protective-and carerelated materials, surveillance, and reducing workloads [23,24] .…”