NOSOCOMIAL OUTBREAK DUE TO ENTEROCOCCUS-FAECIUM HIGHLY RESISTANT TO VANCOMYCIN, PENICILLIN, AND GENTAMICIN

In October 1990, Enterococcus faecium that was highly resistant to gly copeptides, penicillins, and aminoglycosides was isolated from the per itoneal dialysis fluid from a patient in an intensive care unit. Over the following 6 months, multiresistant E. faecium organisms were isola ted from cultures of blood, urine, or surgical wound specimens from ei ght additional patients. Surveillance cultures of groin and/or rectal swabs were positive for eight of 37 patients and four of 62 employees at risk. Restriction endonuclease digestion of chromosomal DNA from ou tbreak isolates was consistent with dissemination of a single strain t hroughout the intensive care unit. Strict infection control interventi ons contained the outbreak after several weeks. Review of patient char ts suggested that renal insufficiency, length of hospital stay, durati on of antibiotic treatment, and prior treatment with vancomycin were r isks for infection due to multiresistant E. faecium. The emergence of multiple-drug-resistant enterococci presents serious infection control and therapeutic dilemmas.