Efficacy of Infect ion Control Strategie sfor Vancomycin: Resistant Enterococci in a Tertiary Care Hospital / 감염

ABSTRACT

BACKGROUND: Vancomycin-resistant enterococci (VRE) have become one of the important nosocomial pathogens. VRE infections are difficult to treat because few antibiotics are effective currently. Since 1998, VRE have been increasingly isolated in a tertiary care hospital with 1253 beds in Korea. To prevent endemic stage of VRE in the hospital, early intervention with intensive infection control strategies was implemented and the efficacy was evaluated. METHODS: Infection control team monitored VREisolated patients prospectively for 8 months (Mar-Oct, 2000). Infection control strategies including contact precaution of patients were applied for the first three months (the 1st phaseMar~May). Rectal cultures were done to identify rectal colonization of VRE from all of the VRE-isolated patients and from their roommates. Health care workers' (HCW) hands and environments related with VRE patients were cultured to identify contaminations or colonizations. More intensive infection control strategies including strict isolation of patients were applied for the following 5 months (the 2nd phase Jun~Oct). Pulsed field gel electrophoresis (PFGE) was done to document genetic relatedness of isolated VRE. RESULTS: Total 26 strains of VRE were isolated from 26 patients during study period. Isolation of VRE had decreased from 1.78 cases per 10,000 patients-days before the study to 1.49 cases during the 1st phase (P=0.4) and to 0.75 cases during the 2nd phase (P=0.02). Rectal colonization rate for VRE isolated patients was 40.9% (9/22); for roommates, 17.1% (12/70). Contamination rate of HCW's hands was 2.3 % (4/ 172) and environmental contamination rate was 8.4% (38/455). Six different PFGE patterns were identified with 43 isolates and 67.6% (29/43) showed the same PFGE patterns. CONCLUSIONS: It was supposed that single clonal epidemic strain had been probably transmitted between the patients, the environments, and the HCW's hands in the hospital. Intensive VRE infection control strategies including strict isolation were very effective to decrease the VRE isolation rate.