Extensive contact tracing and screening to control the spread of vancomycin-resistant Enterococcus faecium ST414 in Hong Kong

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CHENG Vincent Chi-chung(Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China ;Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China)
HO Pak-leung(Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China)
TAI Josepha Wai-ming(Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China)
NG Modissa Lai-ming(Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China)
CHAN Jasper Fuk-woo(Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China)
WONG Sally Cheuk-ying(Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China)
LI Iris Wai-sum(Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China)
CHUNG Hon-ping(Department of Surgery , Tung Wah Hospital, Hong Kong Special Administrative Region, China)
LO Wai-kei(Infection Control Team , Tung Wah Hospital, Hong Kong Special Administrative Region, China)
YUEN Kwok-yung(Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China)
Journal Title:
Chinese Medical Journal
Volume 125, Issue 19, 2012
Key Word:
vancomycin-resistant Enterococcus faecium; ST414; outbreak; contact tracing; screening

Abstract: Background Proactive infection control management is crucial in preventing the introduction of multiple drug resistant organisms in the healthcare setting.In Hong Kong,where vancomycin-resistant enterococci (VRE) endemicity is not yet established,contact tracing and screening,together with other infection control measures are essential in limiting intraand inter-hospital transmission.The objective of this study was to illustrate the control measures used to eradicate a VRE outbreak in a hospital network in Hong Kong.Methods We described an outbreak of VRE in a healthcare region in Hong Kong,involving a University affiliated hospital and a convalescent hospital of 1600 and 550 beds respectively.Computer-assisted analysis was utilized to facilitate contact tracing,followed by VRE screening using chromogenic agar.Multi-locus sequence typing (MLST) was performed to assess the clonality of the VRE strains isolated.A case-control study was conducted to identify the risk factors for nosocomial acquisition of VRE.Results Between November 26 and December 17,2011,11 patients (1 exogenous case and 10 secondary cases) in two hospitals with VRE colonization were detected during our outbreak investigation and screening for 361 contact patients,resulting in a clinical attack rate of 2.8% (10/361).There were 8 males and 3 females with a median age of 78 years (range,40-87 years).MLST confirmed sequence type ST414 in all isolates.Case-control analysis demonstrated that VRE positive cases had a significantly longer cumulative length of stay (P <0.001),a higher proportion with chronic cerebral and cardiopulmonary conditions (P=0.001),underlying malignancies (P <0.001),and presence of urinary catheter (P <0.001),wound or ulcer (P <0.001),and a greater proportion of these patients were receiving 3-Iactam/ β-Iactamase inhibitors (P=0.009),carbapenem group (P <0.001),fluoroquinolones (P=0.003),or vancomycin (P=0.001)when compared with the controls.Conclusion Extensive contact tracing and screening with a "search-and-confine" strategy was a successful tool for outbreak control in our healthcare region.

  • 1.Coia JE,Duckworth G J,Edwards DI,Farrington M,Fry C,Humphreys H,et al.Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities.J Hosp Infect 2006; 63 Suppl 1:s1-s44.
  • 2.Cohen AL,Calfee D,Fridkin SK,Huang SS,Jernigan JA,Lautenbach E,et al.Recommendations for metrics for multidrug-resistant organisms in healthcare settings:SHEA/HICPAC Position paper.Infect Control Hosp Epidemiol 2008; 29:901-913.
  • 3.Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities.MMWR Morb Mortal Wkly Rep 2009; 58:256-260.
  • 4.Nulens E,Broex E,Ament A,Deurenberg RH,Smeets E,Scheres J, et al.Cost of the meticillin-resistant Staphylococcus aureus search and destroy policy in a Dutch university hospital.J Hosp Infect 2008; 68:301-307.
  • 5.Cheng VC,Chan JF,Lau EH,Yam WC,Ho SK,Yau MC,et al.Studying the transmission dynamics of meticillin-resistant Staphylococcus aureus in Hong Kong using spa typing.J Hosp Infect 2011; 79:206-210.
  • 6.Cheng VC,Tai JW,Chan WM,Lau EH,Chan JF,To KK,et al.Sequential introduction of single room isolation and hand hygiene campaign in the control of methicillin-resistant Staphylococcus aureus in intensive care unit.BMC Infect Dis 2010; 10:263.
  • 7.Cheng VC,Tai JW,Ho SK,Chan JF,Hung KN,Ho PL,et al.Introduction of an electronic monitoring system for monitoring compliance with Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" methodology.BMC Infect Dis 2011; 11:151.
  • 8.Bootsma MC, Diekmann O, Bonten MJ.Controlling methicillin-resistant Staphylococcus aureus:quantifying the effects of interventions and rapid diagnostic testing.Proc Natl Acad Sci U S A 2006; 103:5620-5625.
  • 9.Ho PL, Chow KH,Lai EL, Lau EH, Cheng VC.Extended-spectrum-beta-lactamase-positive Escherichia coli mainly adds to, rather than replaces, extendedspectrum-beta-lactamase-negative E.coli in causing bacteraemia in Hong Kong, 2000-2010.J Antimicrob Chemother 2012; 67:778-780.
  • 10.Ho PL,Ho AY,Chow KH,Cheng VC.Surveillance for multidrug-resistant Acinetobacter baumannii:a lesson on definitions.Int J Antimicrob Agents 2010; 36:469-471.
  • 11.Ho PL,Chow KH,Lo PY,Lee KF,Lai EL.Changes in the epidemiology of methicillin-resistant Staphylococcus aureus associated with spread of the ST45 lineage in Hong Kong.Diagn Microbiol Infect Dis 2009; 64:131-137.
  • 12.Cheng VC.Why should vancomycin-resistant enterococci (VRE) be under control in the HKSAR since the first importation in 1997? HK Med Dairy 2011; 16:26-28.
  • 13.Chuang VW,Tsang DN,Lam JK,Lam RK,Ng WH.An active surveillance study of vancomycin-resistant Enterococcus in Queen Elizabeth Hospital,Hong Kong.Hong Kong Med J 2005; 11:463-471.
  • 14.Cheng VC,Chan JF.Tai JW,Ho YY,Li IW,To KK,et al.Successful control of vancomycin-resistant Enterococcus faecium outbreak in a neurosurgical unit at non-endemic region.Emerg Health Threats J 2010; 2:e9.
  • 15.Yang KS,Fong YT,Lee HY,Kurup A,Koh TH,Koh D,et al.Predictors of vancomycin-resistant enterococcus (VRE) carriage in the first major VRE outbreak in Singapore.Ann Acad Med Singapore 2007; 36:379-383.
  • 16.Hoshuyama T,Moriguchi H,Muratani T,Matsumoto T.Vancomycin-resistant enterococci (VRE) outbreak at a university hospital in Kitakyushu,Japan:case-control studies.J Infect Chemother 2008; 14:354-360.
  • 17.Oh HS,Kim EC,Oh MD,Choe KW.Outbreak of vancomycin resistant enterococcus in a hematology/oncology unit in a Korean University Hospital,and risk factors related to patients,staff,hospital care and facilities.Scand J Infect Dis 2004; 36:790-794.
  • 18.Zheng B,Tomita H,Xiao YH,Wang S,Li Y,Ike Y.Molecular characterization of vancomycin-resistant Enterococcus faecium isolates from mainland China.J Clin Microbiol 2007; 45:2813-2818.
  • 19.Cao B,Liu Y,Song S,Li R,Wang H,Wang C.First report of clinical and epidemiological characterisation of vancomycin-resistant enterococci from mainland China.Int J Antimicrob Agents 2008; 32:279-281.
  • 20.Liu Y,Cao B,Gu L,Wang H.Molecular characterization of vancomycin-resistant enterococci in a Chinese hospital between 2003 and 2009.Microb Drug Resist 2011; 17:449-455.
  • 21.Liu Y,Cao B,Gu L,Liu K,Feng Z.Successful control of vancomycin-resistant Enterococcus faecium nosocomial outbreak in a teaching hospital in China.Am J Infect Control 20 l 1; Epub ahead of print.
  • 22.Xu HT,Tian R,Chen DK,Xiao F,Nie ZY,Hu Y J,et al.Nosocomial spread of hospital-adapted CC 17 vancomycin-resistant Enterococcus faecium in a tertiary-care hospital of Beijing,China.Chin Med J 201 l; 124:498-503.
  • 23.Wang Z,Cao B,Liu YM,Gu L,Wang C.Investigation of the prevalence of patients co-colonized or infected with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in China:a hospital-based study.Chin Med J 2009; 122:1283-1288.
  • 24.Matsushima A,Takakura S,Yamamoto M,Matsumura Y,Shirano M,Nagao M,et al.Regional spread and control of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Kyoto,Japan.Eur J Clin Microbiol Infect Dis 2011 ; Epub ahead of print.
  • 25.Zhu X,Zheng B,Wang S,Willems R J,Xue F,Cao X,et al.Molecular characterisation of outbreak-related strains of vancomycin-resistant Enterococcus faecium from an intensive care unit in Beijing,China.J Hosp Infect 2009; 72:147-154.
  • 26.Cheng VC,Tai JW,Ho YY,Chan JF.Successful control of norovirus outbreak in an infirmary with the use of alcohol-based hand rub.J Hosp Infect 2009; 72:370-371.
  • 27.Cheng VC,Wu AK,Cheung CH,Lau SK,Woo PC,Chan KH,et al.Outbreak of human metapneumovirus infection in psychiatric inpatients:implications for directly observed use of alcohol hand rub in prevention of nosocomial outbreaks.J Hosp Infect 2007; 67:336-343.
  • 28.Cheng VC,Wong LM,Tai JW,Chan JF,To KK,Li IW,et al.Prevention of nosocomial transmission of norovirus by strategic infection control measures.Infect Control Hosp Epidemiol 2011; 32:229-237.
  • 29.Cheng VC,Tai JW,Wong LM,Chan JF,Li IW,To KK,et al.Prevention of nosocomial transmission of swine-origin pandemic influenza virus A/H1N1 by infection control bundle.J Hosp Infect 2010; 74:271-217.
  • 30.Armeanu E,Bonten MJ.Control of vancomycin-resistant enterococci:one size fits all? Clin Infect Dis 2005; 41:210-216.
  • 31.Peta M,Carretto E,Barbarini D,Zamperoni A,Carnevale L,Perversi L, et al.Outbreak of vancomycin-resistant Enterococcus spp.in an Italian general intensive care unit.Clin Microbiol Infect 2006; 12:163-169.
  • 32.Ostrowsky BE,Venkataraman L,D'Agata EM,Gold HS,DeGirolami PC, Samore MH.Vancomycin-resistant enterococci in intensive care units:high frequency of stool carriage during a non-outbreak period.Arch Intern Med 1999; 159:1467-1472.
  • 33.Lucet JC,Armand-Lefevre L,Laurichesse JJ,Macrez A,Papy E,Ruimy R,et al.Rapid control of an outbreak of vancomycin-resistant enterococci in a French university hospital.J Hosp Infect 2007; 67:42-48.
  • 34.Pereira GH,Muller PR,Zanella RC,de Jesus Castro Lima M,Torchio DS,Levin AS.Outbreak of vancomycin-resistant enterococci in a tertiary hospital:the lack of effect of measures directed mainly by surveillance cultures and differences in response between Enterococcus faecium and Enterococcus faecalis.Am J Infect Control 2010; 38:406-409.
  • 35.Kurup A,Chlebicki MP,Ling ML,Koh TH,Tan KY,Lee LC,etal.Control of a hospital-wide vancomycin-resistant Enterococci outbreak.Am J Infect Control 2008; 36:206-211.
  • 36.Ledeboer NA,Tibbetts RJ,Dunne WM.A uew chromogenic agar medium, chromlD VRE, to screen for vancomycin-resistant Enterococcus faecium and Enterococcus faecalis.Diagn Microbiol Infect Dis 2007; 59:477-479.
  • 37.Donskey CJ,Chowdhry TK,Hecker MT,Hoyen CK,Hanrahan JA,Hujer AM,et al.Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients.N Engl J Med 2000; 343:1925-1932.
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