Debate—Guidelines for GRE control—the case for optimism

[Glycopeptide-resistant Enterococcus outbreak in an ICU with simultaneous circulation of two different clones]

AIM OF THE STUDY

To describe specific difficulties to control a glycopeptide-resistant Enterococcus (GRE) outbreak occurring in an intensive care unit (ICU) during a regional epidemy.

PATIENTS AND METHODS

Following identification of a GRE clinical isolate in ICU, systematic screening was performed on admission and then weekly, by anal swabs. GRE carriers were isolated according to two processes: first (week [W] 2-W8), cohorting of carriers in a dedicated sector of the ICU, with dedicated HCW; this required closing four of the 16 ICU beds. Second (W8-W29), a specific unit was created outside the ICU. VanA-genotypes and pulsed-field gel electrophoresis (PFGE) profiles were analyzed.

RESULTS

During the first outbreak period (102 rectal swabs), two patients were found colonized at admission: the index case transferred from Nancy hospital, carrier of the Nancy epidemy PFGE profile strain, and one patient from the haemodialysis unit, carrier of a GRE strain presenting a different PFGE profile called the Thionville strain. Seven patients were newly identified as GRE colonized (2 by the Nancy strain and 5 by the Thionville strain). Defective running of the ICU was noted. During the second period (442 samples), six ICU patients were found colonized, including four at admission. No other case was identified in 16 weeks. Outbreak extension to other hospital units was checked at W19. The Thionville strain was not found in other regional hospitals.

CONCLUSION

ICUs concentrate GRE colonization risk. This study demonstrates interest of PFGE. These low virulence bacteria have few direct pathological consequences, but they cause organizational problems in ICUs.