Article
VRE in Switzerland: from first case to the national spread
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Authors
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Niccolò Buetti
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; 3UMR 1137 – IAME Team 5 – DeSCID: Decision SCiences in Infectious Diseases, control and care Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France
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Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| Published: | April 25, 2019 |
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Outline
Text
Background: Vancomycin-resistant enterococci (VRE) are multi-drug resistant microorganisms that cause healthcare-associated infections and are associated with an increased risk of mortality and length of hospital stay. In Switzerland, VRE incidence has not been monitored for infection control purposes at a national level until 2018 [1].
Outbreak at the Bern University Hospital Group: An outbreak investigation was started when two cases of VRE (E. faecium) bloodstream infections (BSIs) were reported on the haemato-oncology ward of Bern University Hospital on 30 December 2017. Four of six hospitals within the Bern University Hospital Group were ultimately affected. As at February 2019, more than 15’000 screening samples have been processed, and 384 patients were found to be colonized or infected with VRE. Only 20 (5.2%) invasive infections were observed. More than 95% of isolates were assigned to the ST796 clone [2]. Before this outbreak, ST796 had exclusively been described in Australia and New Zealand where it exhibited high transmissibility [3].
National investigations: In collaboration with the National Center of Infection Control (Swissnoso) and the Swiss Centre for Antibiotic Resistance (ANRESIS) a national program on VRE epidemiology and the corresponding outbreak investigation was launched in June 2018. Simultaneously, a nation-wide survey on the epidemiology of VRE including was distributed and illustrated an increasing number of VRE colonizations and infections in Switzerland, probably for the most part due to nosocomial dissemination [1]. Moreover, an analysis of enterococcal BSIs from 90 healthcare institutions using ANRESIS data showed an increasing proportion of VRE isolates among E. faecium in 2018.
Outbreak control measures: In September 2018 a national VRE task force published recommendations characterized by the following crucial elements [4]:
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- The first isolation of VRE in a clinical sample strongly suggests undetected VRE carriage and transmission;
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- the detection of a VRE case should trigger screening of all contact patients according to a strategy of concentric circles;
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- the rapidity of detection and isolation of VRE patients and contacts is probably the most critical point.
References
- 1.
- Buetti N, Wassilew N, Rion V, Senn L, Gardiol C, Widmer A, Marschall J; for Swissnoso. Emergence of vancomycin-resistant enterococci in Switzerland: a nation-wide survey. Antimicrob Resist Infect Control. 2019 Jan 17;8:16. DOI: 10.1186/s13756-019-0466-x
- 2.
- Wassilew N, Seth-Smith HM, Rolli E, Fietze Y, Casanova C, Führer U, Egli A, Marschall J, Buetti N. Outbreak of vancomycin-resistant Enterococcus faecium clone ST796, Switzerland, December 2017 to April 2018. Euro Surveill. 2018 Jul;23(29). pii=1800351. DOI: 10.2807/1560-7917.ES.2018.23.29.1800351
- 3.
- Mahony AA, Buultjens AH, Ballard SA, Grabsch EA, Xie S, Seemann T, Stuart RL, Kotsanas D, Cheng A, Heffernan H, Roberts SA, Coombs GW, Bak N, Ferguson JK, Carter GC, Howden BP, Stinear TP, Johnson PDR. Vancomycin-resistant Enterococcus faecium sequence type 796 – rapid international dissemination of a new epidemic clone. Antimicrob Resist Infect Control. 2018 Mar 22;7:44. DOI: 10.1186/s13756-018-0335-z
- 4.
- Vuichard-Gysin D, Troillet N, Senn L, Marschall J, Blanc D, Buetti N, Egli A, et al. Temporary expert guidance for healthcare institutions to contain the spread of vancomycin-resistant enterococci (VRE) in Switzerland. Available from: https://www.swissnoso.ch/fileadmin/swissnoso/Dokumente/1_Swissnoso_allgemein/180912_Temporary_expert_guidance_for_healthcare_institutions_to_contain_the_spread_of_VRE_final_1.0.pdf
