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Abstract

A large clonal outbreak caused by vancomycin-resistant (VRE) affected the Bern University Hospital group from the end of December 2017 until July 2020. We describe the characteristics of the outbreak and the bundle of infection prevention and control (IPC) measures implemented. The outbreak was first recognised when two concomitant cases of VRE bloodstream infection were identified on the oncology ward. During 32 months, 518 patients in the 1,300-bed hospital group were identified as VRE carriers. Eighteen (3.5%) patients developed an invasive infection, of whom seven had bacteraemia. In 2018, a subset of 328 isolates were analysed by whole genome sequencing, 312 of which were identified as sequence type (ST) 796. The initial IPC measures were implemented with a focus on the affected wards. However, in June 2018, ST796 caused another increase in cases, and the management strategy was intensified and escalated to a hospital-wide level. The clinical impact of this large nosocomial VRE outbreak with the emergent clone ST796 was modest. A hospital-wide approach with a multimodal IPC bundle was successful against this highly transmissible strain.

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2022-12-01
2024-11-22
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.48.2200285
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References

  1. Prematunge C, MacDougall C, Johnstone J, Adomako K, Lam F, Robertson J, et al. VRE and VSE bacteremia outcomes in the era of effective VRE therapy: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1):26-35.  https://doi.org/10.1017/ice.2015.228  PMID: 26434609 
  2. Chiang HY, Perencevich EN, Nair R, Nelson RE, Samore M, Khader K, et al. Incidence and outcomes associated with infections caused by vancomycin-resistant enterococci in the United States: systematic literature review and meta-analysis. Infect Control Hosp Epidemiol. 2017;38(2):203-15.  https://doi.org/10.1017/ice.2016.254  PMID: 27825401 
  3. Hemapanpairoa J, Changpradub D, Thunyaharn S, Santimaleeworagun W. Does vancomycin resistance increase mortality? Clinical outcomes and predictive factors for mortality in patients with Enterococcus faecium infections. Antibiotics (Basel). 2021;10(2):105.  https://doi.org/10.3390/antibiotics10020105  PMID: 33499102 
  4. Faron ML, Ledeboer NA, Buchan BW. Resistance mechanisms, epidemiology, and approaches to screening for vancomycin-resistant Enterococcus in the health care setting. J Clin Microbiol. 2016;54(10):2436-47.  https://doi.org/10.1128/JCM.00211-16  PMID: 27147728 
  5. European Centre for Disease Prevention Control (ECDC). Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual Epidemiological Report 2019. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobial-resistance-europe-2019
  6. Senn L, Petignant C, Chabanel D, Zanetti G. [Control of an outbreak of vancomycin-resistant enterococci in several hospitals of western Switzerland]. Rev Med Suisse. 2013;9(383):890-3. French. PMID: 23697084 
  7. Moulin E, Deggim-Messmer V, Erard V, Christin L, Petignat C, Blanc DS, et al. [Vancomycine-resistant enterocci (VRE) : a new reality in our hospitals]. Rev Med Suisse. 2018;14(602):791-4. French.  https://doi.org/10.53738/REVMED.2018.14.602.0791  PMID: 29658219 
  8. Thierfelder C, Keller PM, Kocher C, Gaudenz R, Hombach M, Bloemberg GV, et al. Vancomycin-resistant Enterococcus. Swiss Med Wkly. 2012;142:w13540. PMID: 22618895 
  9. Buetti N, Wassilew N, Rion V, Senn L, Gardiol C, Widmer A, et al. Emergence of vancomycin-resistant enterococci in Switzerland: a nation-wide survey. Antimicrob Resist Infect Control. 2019;8(1):16.  https://doi.org/10.1186/s13756-019-0466-x  PMID: 30675343 
  10. Abdelbary MHH, Senn L, Greub G, Chaillou G, Moulin E, Blanc DS. Whole-genome sequencing revealed independent emergence of vancomycin-resistant Enterococcus faecium causing sequential outbreaks over 3 years in a tertiary care hospital. Eur J Clin Microbiol Infect Dis. 2019;38(6):1163-70.  https://doi.org/10.1007/s10096-019-03524-z  PMID: 30888549 
  11. Vuichard-Gysin D, Sommerstein R, Kronenberg A, Buetti N, Eder M, Piezzi V, et al. High adherence to national IPC guidelines as key to sustainable VRE control in Swiss hospitals: a cross-sectional survey. Antimicrob Resist Infect Control. 2022;11(1):19.  https://doi.org/10.1186/s13756-022-01051-9  PMID: 35090563 
  12. Federal Office of Public Health and Federal Food Safety and Veterinary Office (FOPH). Swiss Antibiotic Resistance Report 2020. Usage of antibiotics and occurrence of antibiotic resistance in Switzerland. Liebefeld: FOPH; 2020. FOPH publication number: 2020-OEG-64. Available from: https://www.anresis.ch/wp-content/uploads/2020/11/Swiss-Antibiotic-Resistance-Report-2020_def_WEB.pdf
  13. Piezzi V, Gasser M, Atkinson A, Kronenberg A, Vuichard-Gysin D, Harbarth S, et al. Increasing proportion of vancomycin-resistance among enterococcal bacteraemias in Switzerland: a 6-year nation-wide surveillance, 2013 to 2018. Euro Surveill. 2020;25(35):1900575.  https://doi.org/10.2807/1560-7917.ES.2020.25.35.1900575  PMID: 32885778 
  14. Mahony AA, Buultjens AH, Ballard SA, Grabsch EA, Xie S, Seemann T, et al. Vancomycin-resistant Enterococcus faecium sequence type 796 - rapid international dissemination of a new epidemic clone. Antimicrob Resist Infect Control. 2018;7(1):44.  https://doi.org/10.1186/s13756-018-0335-z  PMID: 29588851 
  15. Buultjens AH, Lam MM, Ballard S, Monk IR, Mahony AA, Grabsch EA, et al. Evolutionary origins of the emergent ST796 clone of vancomycin resistant Enterococcus faecium. PeerJ. 2017;5:e2916.  https://doi.org/10.7717/peerj.2916  PMID: 28149688 
  16. Coombs G, Bell JM, Daley D, Collignon P, Cooley L, Gottlieb T, et al. Sepsis Outcome Programs. 2019 report. Sydney: Australian Commission on Safety and Quality in Health Care; 2021. Available from: https://www.safetyandquality.gov.au/sites/default/files/2021-02/2019_agar_sepsis_outcome_programs_report.pdf
  17. Stone SP, Cooper BS, Kibbler CC, Cookson BD, Roberts JA, Medley GF, et al. The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection. Lancet Infect Dis. 2007;7(4):282-8.  https://doi.org/10.1016/S1473-3099(07)70082-8  PMID: 17376385 
  18. Federal Office of Public Health (FOPH). Kennzahlen der Schweizer Spitäler 2019. [Key figures for the Swiss hospitals 2019]. Liebefeld: FOPH; 2021. ISSN 1664-7270. German. Available from: https://spitalstatistik.bagapps.ch/data/download/kzp19_publication.pdf?v=1616491353
  19. Clinical Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. CLSI supplement M100. Wayne: CLSI; 2018. Available from
  20. Piezzi V, Luethi A, Suter-Riniker F, Casanova C, Droz S, Marschall J, et al. Diagnostic accuracy and prediction of follow-up positive cultures by Xpert®-vanA/vanB assay from a selective enrichment broth during a vanB vancomycin-resistant Enterococcus faecium outbreak. Poster presentation. 5th International Conference on Prevention and Infection Control (ICPIC 2019); Geneva, Switzerland; 10-13 September 2019. Available from: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0567-6
  21. Furrer L, Luethi A, Casanova C, Sommerstein R, Suter-Riniker F, Bittel P. Evaluation of the diagnostic accuracy of a quadriplex-PCR for detection of vanA/B vancomycin-resistant enterococci in an outbreak situation. Poster presentation. 29th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID); Amsterdam, The Netherlands; 13 – 16 April 2019. Available from: https://www.escmid.org/fileadmin/eccmid/2019/media/documents/Final_Programme_web.pdf
  22. Frakking FNJ, Bril WS, Sinnige JC, Klooster JEV, de Jong BAW, van Hannen EJ, et al. Recommendations for the successful control of a large outbreak of vancomycin-resistant Enterococcus faecium in a non-endemic hospital setting. J Hosp Infect. 2018;100(4):e216-25.  https://doi.org/10.1016/j.jhin.2018.02.016  PMID: 29475013 
  23. Mohn SC, Ulvik A, Jureen R, Willems RJ, Top J, Leavis H, et al. Duplex real-time PCR assay for rapid detection of ampicillin-resistant Enterococcus faecium. Antimicrob Agents Chemother. 2004;48(2):556-60.  https://doi.org/10.1128/AAC.48.2.556-560.2004  PMID: 14742209 
  24. Wassilew N, Seth-Smith HM, Rolli E, Fietze Y, Casanova C, Führer U, et al. Outbreak of vancomycin-resistant Enterococcus faecium clone ST796, Switzerland, December 2017 to April 2018. Euro Surveill. 2018;23(29):1800351.  https://doi.org/10.2807/1560-7917.ES.2018.23.29.1800351  PMID: 30043725 
  25. Vuichard-Gysin D, Schlegel M, Troillet N, Senn L, Marschall J, Blanc DS, et al. Eindämmung der Verbreitung von Vancomycin-resistenten Enterokokken (VRE) in der Schweiz: Aktualisierung der nationalen Empfehlungen. [Expert guidance for healthcare institutions to contain the spread of vancomycin resistant enterococci (VRE) in Switzerland]. Version 2.0. Bern: Swissnoso; 2019. German. Available from: https://swissnoso.ch/fileadmin/swissnoso/Dokumente/5_Forschung_und_Entwicklung/6_Aktuelle_Erreignisse/191220_Aktualisierte_VRE_Management_Guideline_final_rev.pdf
  26. Leong KWC, Cooley LA, Anderson TL, Gautam SS, McEwan B, Wells A, et al. Emergence of vancomycin-resistant Enterococcus faecium at an Australian Hospital: a whole genome sequencing analysis. Sci Rep. 2018;8(1):6274.  https://doi.org/10.1038/s41598-018-24614-6  PMID: 29674657 
  27. Nürnberger L, Schmidt D, Szumlanski T, Kirchhoff L, Ross B, Steinmann J, et al. Molecular characterization of vancomycin-resistant Enterococcus faecium isolates from two German hospitals. GMS Hyg Infect Control. 2021;16:Doc13. PMID: 33796441 
  28. Eisenberger D, Tuschak C, Werner M, Bogdan C, Bollinger T, Hossain H, et al. Whole-genome analysis of vancomycin-resistant Enterococcus faecium causing nosocomial outbreaks suggests the occurrence of few endemic clonal lineages in Bavaria, Germany. J Antimicrob Chemother. 2020;75(6):1398-404.  https://doi.org/10.1093/jac/dkaa041  PMID: 32083651 
  29. Werner G, Neumann B, Weber RE, Kresken M, Wendt C, Bender JK, et al. Thirty years of VRE in Germany - "expect the unexpected": The view from the National Reference Centre for Staphylococci and Enterococci. Drug Resist Updat. 2020;53:100732.  https://doi.org/10.1016/j.drup.2020.100732  PMID: 33189998 
  30. Fioriti S, Simoni S, Caucci S, Morroni G, Ponzio E, Coccitto SN, et al. Trend of clinical vancomycin-resistant enterococci isolated in a regional Italian hospital from 2001 to 2018. Braz J Microbiol. 2020;51(4):1607-13.  https://doi.org/10.1007/s42770-020-00360-8  PMID: 32783169 
  31. Rogers LA, Strong K, Cork SC, McAllister TA, Liljebjelke K, Zaheer R, et al. The role of whole genome sequencing in the surveillance of antimicrobial resistant Enterococcus spp.: a scoping review. Front Public Health. 2021;9:599285.  https://doi.org/10.3389/fpubh.2021.599285  PMID: 34178909 
  32. Egli A, Blanc DS, Greub G, Keller PM, Lazarevic V, Lebrand A, et al. Improving the quality and workflow of bacterial genome sequencing and analysis: paving the way for a Switzerland-wide molecular epidemiological surveillance platform. Swiss Med Wkly. 2018;148:w14693.  https://doi.org/10.4414/smw.2018.14693  PMID: 30552858 
  33. Lai CK, Wong SY, Lee SS, Siu HK, Chiu CY, Tsang DN, et al. A hospital-wide screening programme to control an outbreak of vancomycin-resistant enterococci in a large tertiary hospital in Hong Kong. Hong Kong Med J. 2017;23(2):140-9.  https://doi.org/10.12809/hkjr1715387  PMID: 28232642 
  34. Weterings V, van Oosten A, Nieuwkoop E, Nelson J, Voss A, Wintermans B, et al. Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014-2017: successful control using a restrictive screening strategy. Antimicrob Resist Infect Control. 2021;10(1):38.  https://doi.org/10.1186/s13756-021-00906-x  PMID: 33602300 
  35. Hughes A, Ballard S, Sullivan S, Marshall C. An outbreak of vanA vancomycin-resistant Enterococcus faecium in a hospital with endemic vanB VRE. Infect Dis Health. 2019;24(2):82-91.  https://doi.org/10.1016/j.idh.2018.12.002  PMID: 30638872 
  36. Ziakas PD, Thapa R, Rice LB, Mylonakis E. Trends and significance of VRE colonization in the ICU: a meta-analysis of published studies. PLoS One. 2013;8(9):e75658.  https://doi.org/10.1371/journal.pone.0075658  PMID: 24086603 
  37. Atkinson A, Ellenberger B, Piezzi V, Kaspar T, Endrich O, Leichtle AB, et al. A Bayesian spatiotemporal model for prevalence estimation of a VRE outbreak in a tertiary care hospital. J Hosp Infect. 2022;122:108-14.  https://doi.org/10.1016/j.jhin.2021.12.024  PMID: 35090955 
  38. Atkinson A, Ellenberger B, Piezzi V, Kaspar T, Salazar-Vizcaya L, Endrich O, et al. Extending outbreak investigation with machine learning and graph theory: Benefits of new tools with application to a nosocomial outbreak of a multidrug-resistant organism. Infect Control Hosp Epidemiol. 2022;1-7.  https://doi.org/10.1017/ice.2022.66  PMID: 36111457 
Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, Switzerland, 2017 to 2020
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Vanja+Piezzi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Piezzi Vanja</a>, <a href="/search?value1=Nasstasja+Wassilew&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wassilew Nasstasja</a>, <a href="/search?value1=Andrew+Atkinson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Atkinson Andrew</a>, <a href="/search?value1=St%C3%A9phanie+D%26apos%3BIncau&option1=author&noRedirect=true" class="nonDisambigAuthorLink">D&apos;Incau Stéphanie</a>, <a href="/search?value1=Tanja+Kaspar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kaspar Tanja</a>, <a href="/search?value1=Helena+MB+Seth-Smith&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Seth-Smith Helena MB</a>, <a href="/search?value1=Carlo+Casanova&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Casanova Carlo</a>, <a href="/search?value1=Pascal+Bittel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bittel Pascal</a>, <a href="/search?value1=Philipp+Jent&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jent Philipp</a>, <a href="/search?value1=Rami+Sommerstein&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sommerstein Rami</a>, <a href="/search?value1=Niccol%C3%B2+Buetti&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Buetti Niccolò</a>, <a href="/search?value1=Jonas+Marschall&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Marschall Jonas</a></span>. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, Switzerland, 2017 to 2020. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(48):pii=2200285. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.48.2200285" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.48.2200285</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 29 Mar 2022;&nbsp;&nbsp; <span class="generated">Accepted</span>: 11 Aug 2022 </span> </p>
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