Our experiences with vancomycin-resistant enterococci in Jesenice General hospital

  • Helena Ribič
  • Irena Grmek-Košnik
  • Zdenka Kramar
  • Igor Rus
Keywords: vancomycin-resistant enterococci, hospital infections


Background: Vancomycin-resistant enterococci (VRE) present a great problem in health care, especially because of their resistance to many groups of antibiotics and because of the way of their spreading in health care and long-term care institutions. Genes responsible for resistance to vancomycin can be transmitted to other species of enterococci and also to other grampositive cocci, for example Staphylococcus aureus. Experts anticipate that failure to control methicilin-resistant S. aureus and VRE may make control of vancomycin-resistant S. aureus impossible.

Methods: In the medical microbiology laboratory of Institute Public Health Kranj we perform microbiology diagnosis for Jesenice General Hospital, where surveillance culturing for VRE started in May 2007. Until 15th June, 364 surveillance samples for VRE were taken from 92 patients. We also analysed the results of enterococci that were isolated in our laboratory during routine work in the period from 2004 to 2006.

Results: In the three-year period we isolated 1593 strains of enterococci and among them 7 strains were VRE. In the Jesenice General Hospital, the first strain of vancomycin-resistant Enterococcus faecium was isolated in May 2007 in a patient, treated in internal intensive care unit. Nine strains of VRE with the same resistance type in nine patients followed the first case. The first four patients with VRE were moved from the same hospital. Among next six patients the common risk factor was contact with VRE positive patient.

Conclusions: Control of VRE strains claims for intensive action. Active surveillance of colonised and infected patients, contact precautions with barrier isolation, intensive hand hygiene measures, aggressive environmental decontamination and prudent use of antimicrobials are needed.


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Martins Teixiera L, Facklam RR. Enterococcus. In: Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH. Manual of clinical microbiology. 8th edition. Washington: ASM; 2003. p. 422– 33.

Moellering RC. Enterococcus Species, Streptococcus bovis and Leuconostoc Species. In: Mandell GL, Bennett JE, Dolin R. Mandell. Douglas and Bennett’s principles and practice in infectious diseases. 6th edition. Philadelphia: Churchill Livingstone; 2005. p. 2411–22.

DeLisle S, Perl TM. Vancomycin-resistant enterococci: a road map on how to prevent the emergence and transmission of antimicrobial resistance. Chest 2003; 123 Suppl 5: 504–18.

Guardabassi L, Dasgaard A. Occurrence, structure, and mobility of Tn1546-like elements in environmental isolates of vancomycin-resistant enterococci. Appl Environ Microbiol 2004; 70: 984–90.

Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA Guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003; 24: 362– 86.

EARSS Management Team, members of the Advisory Board, national representatives of EARSS. EARSS annual reports 2001– 2005. Dosegljivo na: URL: http://www.rivm.nl/earss

Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing. Sixteenth informational supplement. Document M100-S16. CLSI: Villanova, PA; 2006.

Clinical and laboratory standards institute. Performance standards for antimicrobial disk susceptibility tests; Approved standard – ninght Edition. CLSI document M2-A9. CLSI: Villanova, PA ; 2006.

Ostrowsky BE, Trick WE, Sohn AH, Quirk SB, Holt S, Carson LA, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med 2001; 344: 1427–33.

Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing. Seventeenth informational supplement. Document M100-S17. CLSI: Villanova, PA; 2007.

Leclercq R, Derlot E, Duval J, Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988; 319: 157–61.

Sahm DF, Kissinger J, Gilmore MS. In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis. Antimicrob Agents Chemother 1989; 33: 1588–91.

Rodriguez JC, Galindo-Fraga A, Guevara V, Perez-Jimenez C, Espinosa-Aguilar L, Rolon AL, et al. Vancomycin-resistant Enterococci, Mexico City. Emerging Infectious Diseases 2007; 13: 798–9.

Endtz HP, Braak N, Belkum A, Kluytmans JAJ, Koeleman JGM, Spanjaard L, et al. Fecal carriage of vancomycin-resisant enterococci in hospitalized patients and those living in the community in the Netherlands. J Clin Microbiol 1997; 35: 3026–31.

National nosocomial Infections Surveillance system participating hospitals. Hospital Infections Program, National center for infectious diseases, CDC. Nosocomial enterococci resistant to vancomycin – United States 1989–1993. MMWR 1993; 42: 597–600.

Anon. National nosocomial surveillance system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32: 470–85.

Finch R. Gram-positive infections: lessons learnt and novel solutions. Clin Microbiol Infect 2006; 12 Suppl: 3–8.

Ammerlaan HSM, Bonten MJM. Daptomycin: graduation day. Clin Microbiol Infect 2006; 12 Suppl: 22–8.

Centers for Disease Control and Prevention. Vancomycin-resistant Staphylococcus aureus – Pennsylvania, 2002. MMWR 2002; 51: 902.

Hospital Infection Control Practices Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance. MMWR 1995; 44: RR-12.

Bhorade SM, Christenson J, Pohlman AS, Arnow PM, Hall JB. The incidence of and clinical variables associated with vancomycinresistant enterococcal colonization in mechanically ventilated patients. Chest 1999; 115: 1085–91.

Sherer CR, Sprague BM, Campos JM, Nambiar S, Temple R, Short B, et al. Characterizing vancomycin-resistant enterococci in neonatal intensive care. Emerg Infect Dis 2005; 11: 1470–2.

Gubina M, Dolinšek M, Škerl M. Bolnišnična higiena. Ljubljana: MF, Katedra za mikrobiologijo in imunologijo; 1998.

Kramar Z. Epidemiološko spremljanje bolnišničnih okužb s podporo informacijskega sistema. Ljubljana: Zbornica zdravstvene nege, zveza društev medicinskih sester in zdravstvenih tehnikov; 2002.

Ministry of Health and Long-Term Care Ontario. Best practises for infection prevention and control of resistant Staphylococcus aureus and Enterococci in all health care settings. Dosegljivo na URL http://www.health.gov.on.ca

Ieven M, Vercauteren E, Descheemaeker P, Laer F, Goosens H. Comparison of direct plating and broth enrichment culture for the detection of intestinal colonisation by glycopeptide-resistant enterococci among hospitalized patients. J Clin Microbiol 1999; 37: 1436–40.

Siegel JD, Rhinehart E, Jackson M, Chiarello L. The Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. CDC.

Porwancher R, Sheth A, Remphrey S, Taylor E, Hinkle C, Zervos M. Epidemiological study of hospital-acquired infection with vancomycin-resistant Enterococcus faecium: possible transmission by an electronic ear-probe thermometer. Infect Control Hosp Epidemiol 1997; 18: 771–3.

Falk PS, Winnike J, Woodmansee C, Desai M, Mayhall CG. Outbreak of vancomycin-resistant enterococci in a burn unit. Infect Control Hosp Epidemiol 2000; 21: 575–82.

Gordts B, Van Landuyt H, Ieven M, Vandamme P, Goossens H. Vancomycin-resistant enterococci colonizing the intestinal tracts of hospitalized patients. J Clin Microbiol 1995; 33: 2842–6.

How to Cite
Ribič H, Grmek-Košnik I, Kramar Z, Rus I. Our experiences with vancomycin-resistant enterococci in Jesenice General hospital. ZdravVestn [Internet]. 1 [cited 22Nov.2019];76(11). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/1911
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