Vancomycin-resistant enterococci colonisation in the ICU and control measures

Introduction

Vancomycin-resistant enterococci (VRE) have been recognised as microorganisms capable of causing epidemics in critically ill patients [1]. The present report describes an outbreak involving VRE colonisation in our ICU.

Methods

After several weeks of severe nursing shortage, when often there were only three nurses for 10 critically ill patients, the first VRE was isolated from one of the two blood cultures of a trauma patient. Rectal swabs of all of the patients' and ICU staff were collected. Because there was no patient who had been discharged to the ward during this period no further analysis was required.

Results

Enterococcus casseliflavus was isolated from six out of the 10 patients' rectal swabs. Once the outbreak was identified, all patients were placed under strict contact isolation and cohorted, and barrier precautions were instituted. Four patients who had negative rectal swabs were isolated in another ICU. Five of the patients did not demonstrate signs of infection and were accepted as colonisation. ICU staff had negative rectal swabs. Two of the patients who had positive rectal swabs had died because of underlying primary disease (acute myocardial infarction, acute respiratory distress syndrome due to aspiration pneumonia). The first patient who had a positive blood culture was treated with intravenous Linezolid and discharged to home after 14 days. Another patient who had sepsis due to necrotising fasciitis was discharged to the ward after obtaining three negative rectal swabs. The other patient who had non-Hodgkin lymphoma and pneumonia was discharged to the ward after obtaining three negative rectal swabs. The last patient was isolated in another room and followed up for 4 weeks and discharged to the ward after obtaining three negative rectal swabs.

Conclusion

The outbreak was controlled by continuous implementation of the infection control programme. A long ICU stay, hemodialysis, and nursing shortage are risk factors for VRE development. Transmission of VRE can be facilitated by the hands of the staff. We conclude that this outbreak may be due to the shortage of nursing during summer.