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Rapid Curbing of a Vancomycin-Resistant Enterococcus faecium Outbreak in a Nephrology Department

Aude Servais^*,, Lucile Mercadal^,, Florence Brossier^||,¶, Marcia Venditto^,, Belkacem Issad^,, Corinne Isnard-Bagnis^,, Gilbert Deray^,, and Jérôme Robert^||,¶

^* Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France; Université Paris–Descartes, Paris, France; Department of Nephrology and ^|| Department of Bacteriology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Université Pierre et Marie Curie-Paris 6, Paris, France; and ^¶ Université Pierre et Marie Curie-Paris 6, Laboratoire de Bactériologie-Hygiène, Paris, France

Correspondence: Dr. Aude Servais,Department of Nephrology, Necker Hospital, 149, rue de Sèvres, 75015 Paris, France. Phone: 33-1-44-38-15-15; Fax: 33-1-44-49-54-50; E-mail: aude.servais{at}nck.aphp.fr

Background and objectives: Vancomycin-resistant enterococci (VRE) are recovered with increasing frequency among patients with chronic renal failure, making VRE a major concern in nephrology departments, especially for patients who are treated by hemodialysis. We report herein the successful aggressive management of a VRE outbreak in a nephrology department.

Design, setting, participants, & measurements: An Enterococcus faecium vanB strain was isolated from a peritoneal dialysis solution from an inpatient. Immediately, infection control measures were enforced and active screening was performed for all contact patients. Carriers were isolated, and patients were divided into three cohorts: Positive, contact, and noncontact patients. We then performed a case-control study to understand risk factors for VRE carriage comparing VRE carriers with contact patients who were negative for VRE.

Results: A total of 14 VRE-positive and 125 VRE-negative contact patients were identified. VRE-positive patients were more likely to receive hemodialysis and have longer hospital stays in nephrology. VRE-positive patients more often had a central venous catheter for a longer period of time and received more antibiotics than VRE-negative patients. Treatment with large-spectrum β-lactams and number of days in the nephrology ward were significantly associated with a higher risk for VRE carriage by using multivariate analysis.

Conclusions: These findings suggest that case mix, longer hospital stays, and antibiotic use are major risk factors for VRE acquisition. In addition, it demonstrates that strict enforcement of isolation precautions and cohorting associated with active screening are successful to curb the transmission of VRE in renal units despite continuous colonization pressure.