Long-term control of vancomycin-resistant Enterococcus faecium at the scale of a large multihospital institution: a seven-year experience

S Fournier; F Brossier; N Fortineau; F Gillaizeau; A Akpabie; A Aubry; F Barbut; F X Chedhomme; N Kassis-Chikhani; J C Lucet; J Robert; D Seytre; I Simon; D Vanjak; J R Zahar; C Brun-Buisson; V Jarlier

doi:10.2807/ese.17.30.20229-en

Surveillance and outbreak reports Open Access

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Long-term control of vancomycin-resistant Enterococcus faecium at the scale of a large multihospital institution: a seven-year experience
S Fournier¹ , F Brossier² , N Fortineau³ , F Gillaizeau⁴ , A Akpabie⁵ , A Aubry⁶ , F Barbut⁷ , F X Chedhomme⁸ , N Kassis-Chikhani⁹ , J C Lucet¹⁰ , J Robert² , D Seytre¹¹ , I Simon¹² , D Vanjak¹³ , J R Zahar¹⁴ , C Brun-Buisson¹⁵ , V Jarlier^1,2
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Affiliations: ¹ Direction de la Politique Médicale (Directorate of Medical Politics), Assistance Publique-Hôpitaux de Paris, Paris, France ² Bacteriology laboratory, Université Pierre et Marie CURIE – Paris 6, Hôpital Pitié-Salpêtrière, Assistance publique – Hôpitaux de Paris, Paris, France ³ Bicêtre Hospital, Assistance publique – Hôpitaux de Paris, Kremlin-Bicêtre, France ⁴ Departement of hospital informatics, European hospital Georges Pompidou, Assistance publique – Hôpitaux de Paris, Paris, France ⁵ Emile Roux Hospital, Assistance publique – Hôpitaux de Paris, Limeil-Brévannes, France ⁶ Charles Foix Hospital, Assistance publique – Hôpitaux de Paris, Ivry-Sur-Seine, France ⁷ Saint Antoine Hospital, Assistance publique – Hôpitaux de Paris, Paris, France ⁸ La Collégiale Hospital, Assistance publique – Hôpitaux de Paris, Paris, France ⁹ Paul Brousse Hospital, Assistance publique – Hôpitaux de Paris, Villejuif, France ¹⁰ Bichat-Claude Bernard Hospital, Assistance publique – Hôpitaux de Paris, Paris, France ¹¹ Avicenne Hospital, Assistance publique – Hôpitaux de Paris, Bobigny, France ¹² Sainte Périne Hospital, Assistance publique – Hôpitaux de Paris, Paris, France ¹³ Beaujon Hospital, Assistance publique – Hôpitaux de Paris, Beaujon, France ¹⁴ Necker Hospital, Assistance publique – Hôpitaux de Paris, Paris, France ¹⁵ Henri Mondor Hospital, Assistance publique – Hôpitaux de Paris, Créteil, France

Correspondence:
S Fournier
sandra.fournier sap.aphp.fr
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Citation style for this article: Fournier S, Brossier F, Fortineau N, Gillaizeau F, Akpabie A, Aubry A, Barbut F, Chedhomme F X, Kassis-Chikhani N, Lucet J C, Robert J, Seytre D, Simon I, Vanjak D, Zahar J R, Brun-Buisson C, Jarlier V. Long-term control of vancomycin-resistant Enterococcus faecium at the scale of a large multihospital institution: a seven-year experience. Euro Surveill. 2012;17(30):pii=20229. https://doi.org/10.2807/ese.17.30.20229-en Received: 17 Jan 2012

Abstract

Repeated outbreaks of vancomycin-resistant Enterococcus faecium (VRE) occurred between 2004 and 2010 in Assistance Publique - Hôpitaux de Paris (AP-HP), a 23,000-bed multi-hospital institution. From August 2004 to December 2005, the French guidelines for preventing cross-transmission of multiresistant bacteria were applied. Because the number of VRE cases continued to increase, an institutional control programme was implemented from January 2006 onwards: It foresees stopping transfer of VRE and contact patients, separating VRE and contact patients in distinct cohorts, intervention of a central infection control team to support local teams, and quick application of measures as soon as first VRE cases are identified. Between August 2004 and December 2010, 45 VRE outbreaks occurred in 21 of the 38 AP-HP hospitals, comprising 533 cases. Time series analysis showed that the mean number of cases increased by 0.8 cases per month (95% confidence interval (CI): 0.3 to 1.3, p=0.001) before, and decreased by 0.7 cases per month after implementation of the programme (95% CI: -0.9 to -0.5, p<0.001), resulting in a significant trend change of -1.5 cases per month (95% CI: -2.1 to -0.9, p<0.001). The number of cases per outbreak was significantly lower after implementation of the programme. A sustained and coordinated strategy can control emerging bacteria at the level of a large regional multihospital institution. .