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Vancomycin-resistant Enterococcus (VRE) outbreak in a neonatal intensive care unit and special care nursery at a tertiary-care hospital in Australia—A retrospective case-control study

Published online by Cambridge University Press:  14 March 2019

Patiyan Andersson Open the ORCID record for Patiyan Andersson [Opens in a new window] ,
Wendy Beckingham ,
Claire Louise Gorrie ,
Karina Kennedy ,
Kathryn Daveson ,
Susan Alicia Ballard ,
Ming Chen ,
Katrina Roper  and
Nicholas Coatsworth
Patiyan Andersson*
Affiliation:
National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
Wendy Beckingham
Affiliation:
Infection Prevention and Control, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia
Claire Louise Gorrie
Affiliation:
Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
Karina Kennedy
Affiliation:
Infectious Disease and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
Kathryn Daveson
Affiliation:
Infectious Disease and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
Susan Alicia Ballard
Affiliation:
Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
Ming Chen
Affiliation:
Infectious Disease and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia
Katrina Roper
Affiliation:
National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
Nicholas Coatsworth
Affiliation:
Infectious Disease and Microbiology, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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Abstract

Objective:

We investigated the risk factors and origins of the first known occurrence of VRE colonization in the neonatal intensive care unit (NICU) at the Canberra Hospital.

Design:

A retrospective case-control study.

Setting:

A 21-bed neonatal intensive care unit (NICU) and a 15-bed special care nursey (SCN) in a tertiary-care adult and pediatric hospital in Australia.

Patients:

All patients admitted to the NICU and SCN over the outbreak period: January–May 2017. Of these, 14 were colonized with vancomycin-resistant Enterococcus (VRE) and 77 were noncolonized.

Methods:

Demographic and clinical variables of cases and controls were compared to evaluate potential risk factors for VRE colonization. Whole-genome sequencing of the VRE isolates was used to determine the origin of the outbreak strain.

Results:

Swift implementation of wide-ranging infection control measures brought the outbreak under control. Multivariate logistic regression revealed a strong association between early gestational age and VRE colonization (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.94–7.00). Whole-genome sequencing showed the isolates to be highly clonal Enterococcus faecium ST1421 harboring a vanA gene and to be closely related to other ST1421 previously sequenced from the Canberra Hospital and the Australian Capital Territory.

Conclusion:

The colonization of NICU patients was with a highly successful clone endemic to the Canberra Hospital likely introduced into the NICU environment from other wards, with subsequent cross-contamination spreading among the neonate patients. Use of routine surveillance screening may have identified colonization at an earlier stage and have now been implemented on a 6-monthly schedule.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 5 , May 2019 , pp. 551 - 558
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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