Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Neoplasias Hematológicas/complicaciones , Control de Infecciones/métodos , Infecciones por Virus Sincitial Respiratorio/epidemiología , Adulto , Antivirales/efectos adversos , Antivirales/uso terapéutico , Espasmo Bronquial/inducido químicamente , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/prevención & control , Infección Hospitalaria/transmisión , Susceptibilidad a Enfermedades , Femenino , Higiene de las Manos , Hematología , Departamentos de Hospitales , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico , Infecciones por Virus Sincitial Respiratorio/prevención & control , Infecciones por Virus Sincitial Respiratorio/transmisión , Ribavirina/efectos adversos , Ribavirina/uso terapéuticoAsunto(s)
Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/epidemiología , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Trasplante de Células Madre Hematopoyéticas , Unidades Hospitalarias , Infecciones por Clostridium/prevención & control , Infecciones por Clostridium/transmisión , Infección Hospitalaria/microbiología , Brotes de Enfermedades/prevención & control , Desinfección de las Manos , Humanos , Gestión de Riesgos , España/epidemiologíaRESUMEN
OBJECTIVES: To report a clonal outbreak of ST17 vancomycin-resistant Enterococcus faecium (VREfm) carrying Tn1546 (vanA) in a haemo-oncology ward of a tertiary teaching hospital in the south of Spain (January-September 2009). PATIENTS AND METHODS: Twenty-two VREfm strains from 13 patients were characterized by PFGE, multiple-locus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST). Genes encoding antibiotic resistance and putative virulence traits and the Tn1546 backbone were investigated by PCR. Plasmid characterization included determination of size (S1-PFGE) and replication modules (PCR, hybridization and sequencing). Patient clinical records were analysed retrospectively. RESULTS: A single ST17 E. faecium clone (MT-7 MLVA type) carrying esp and hyl plus a 30 kb Inc18-like::Tn1546 (IS1216) plasmid was identified. Ampicillin resistance was linked to PBP5 showing mutations at positions 24, 27, 34, 66, 68, 85, 100, 144, 172, 177, 204, 216, 324, 462, 466', 470, 485, 496, 499, 525, 546, 558, 582, 586, 629, 632, 642 and 667. Other resistance genes identified were erm(B), ant(6')-Ia and aph(3')-IIIa. Fluoroquinolone resistance was attributable to ParC (Arg-61 â Gly and Ser-80 â Arg) and GyrA (Ser-83 â Arg) mutations. CONCLUSIONS: A nosocomial outbreak caused by an ST17 (CC17) E. faecium clone harbouring Esp and Hyl and a 30 kb Inc18-like::Tn1546 plasmid among haemo-oncology patients is reported. The failure of early infection control practices indicates an undetected reservoir and the ability of this strain to persist over long periods. The potential spread of epidemic clones and broad host plasmids carrying vancomycin resistance in Spain is of concern since it might contribute towards a higher rate of VREfm infection.