Jm. Boyce et al., OUTBREAK OF MULTIDRUG-RESISTANT ENTEROCOCCUS-FAECIUM WITH TRANSFERABLE VANB CLASS VANCOMYCIN RESISTANCE, Journal of clinical microbiology, 32(5), 1994, pp. 1148-1153
Enterococcus faecium strains resistant to ampicillin, high levels of g
entamicin, and vancomycin but susceptible to teicoplanin (vanB class v
ancomycin resistance) were recovered from 37 patients during an outbre
ak involving a 250-bed university-affiliated hospital. Three isolates
with vancomycin MICs ranging from 8 to 256 mu g/ml all hybridized with
a vanB probe. Restriction endonuclease analysis of chromosomal and pl
asmid DNA suggested that all isolates tested were derived from a singl
e clone. Vancomycin resistance was shown to be transferable. Risk fact
ors for acquiring the epidemic strain included proximity to another ca
se patient (P, 0.0005) and exposure to a nurse who cared for another c
ase patient (P, 0.007). Contamination of the environment by the epidem
ic strain occurred significantly more often when case patients had dia
rrhea (P, 0.001). Placing patients in private rooms and requiring the
use of gowns as,veil as gloves by personnel controlled the outbreak Th
ese findings suggest that multidrug-resistant E. faecium strains with
transferable vanB class vancomycin resistance will emerge as important
nosocomial pathogens. Because extensive environmental contamination m
ay occur when affected patients develop diarrhea, barrier precautions,
including the use of both gowns and gloves, should be implemented is
soon as these pathogens are encountered.