Major articleOutbreak of vanB vancomycin-resistant Enterococcus faecium colonization in a neonatal service
Section snippets
Setting
Monash Newborn consists of a 54-bed level III NICU (Clayton, Melbourne, Australia) and 2 special care (level II) nurseries with capacity of 14 beds and 6 beds located at 2 separate campuses. A private special care nursery of 5 beds is colocated at the Clayton campus, but staffed and administered separately in a different facility from the NICU. Unwell or at-risk neonates are admitted directly after birth into either the NICU or special care nurseries (SCNs), depending upon the severity of their
Outbreak description
A total of 44 cases of VREfm carriage were detected between October 14, 2013, and January 10, 2014 (as shown in Fig 1). Twenty-five cases (57%) were at Clayton, the remainder occurring across the 3 satellite sites. The median baby age at detection of VREfm colonization was 22.5 days (range, 4-138 days). Median birth weight was 2,005 g (mean, 2,042 g; range, 725-4,300 g) and median gestational age was 33 weeks (mean, 33 weeks; range, 25-41 weeks) for 40 babies for whom data was available. The
Discussion
We describe a large outbreak of vanB ST796 VREfm in a neonatal setting that was successfully terminated by the application of contact precautions and enhanced cleaning. Previous neonatal outbreaks have been confined to the Northern Hemisphere, have included mostly vanA strains (only 1 report involving vanB2), and have mostly reported low rates of clinical infection as well as termination with combinations of infection control interventions, including active surveillance cultures, environment
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Cited by (28)
Vancomycin-resistant Enterococcus faecium and the emergence of new sequence types associated with hospital infection
2023, Research in MicrobiologyThe changing molecular epidemiology of Enterococcus faecium harbouring the van operon at a teaching hospital in Western Australia: A fifteen-year retrospective study
2022, International Journal of Medical MicrobiologyCitation Excerpt :In Australia, vancomycin resistance in E. faecium is typically conferred by the acquisition of the vanA or vanB operon. Initially reported in Australia in 1995 (Kamarulzaman et al., 1995), vancomycin resistant E. faecium (VREfm) is now endemic in many Australian hospitals with outbreaks reported regularly (Coombs et al., 2018; Johnson et al., 2010; Lister et al., 2015). In this study, we retrospectively analyse a fifteen-year collection of E. faecium harbouring the van operon from Royal Perth Hospital (RPH), a 450-bed teaching hospital located in Perth, Western Australia (Lee et al., 2019).
Evolution of virulence in Enterococcus faecium, a hospital-adapted opportunistic pathogen
2018, Current Opinion in MicrobiologyCitation Excerpt :Transmission and spread of health care-associated clade A1 (CC17) E. faecium is increasing worldwide [14–16,17•]. Several retrospective longitudinal studies have independently revealed how new health care-associated clones rapidly emerge, often arising by intra-genus recombination and displacing existing E. faecium clones [18–22]. Focused examination of a recently emerged E. faecium clone in Australia underscores the propensity of clade A1 members to mutate.
Microfiber and steam for a neonatal service: An improved and safe cleaning methodology
2017, American Journal of Infection ControlClearance of infant vancomycin-resistant Enterococcus faecium carriage after a neonatal inpatient outbreak
2016, American Journal of Infection ControlCitation Excerpt :The study institution experienced an outbreak of vanB-type VREfm colonization in its neonatal inpatient service, which has previously been described.3
A nonclonal outbreak of vancomycin-sensitive Enterococcus faecalis bacteremia in a neonatal intensive care unit
2019, Infection Control and Hospital Epidemiology
This work was supported by a grant from the National Health and Medical Research Council of Australia (No. 1027874).
Conflicts of interest: None to report.