Resolution of a vanA VRE outbreak with no change in vanB VRE

Matthew Richards 1, Kathryn Williams 1, Louise Hobbs 1, Caroline Marshall 1

Melbourne Health, Melbourne, VIC, Australia


During an outbreak of vanA vancomycin-resistant enterococcus (VRE) in our intensive care unit (ICU) and cardiothoracic surgery ward (CTW), multiple infection control interventions were put in place resulting in resolution of the outbreak, yet we continued to have high rates of vanB VRE despite these measures.

A multi-faceted approach to containing this outbreak included: reinforcement of transmission based precautions, hand hygiene and compliance with cleaning. Additionally other strategies were introduced such as chlorhexidine body washes. Admission, discharge and weekly rectal swabs for VRE screening were commenced in ICU and CTW and from which vanA and vanB VRE incidence and prevalence were determined.

Between June 1 2015 and May 31 2016, 1452 VRE screening swabs were obtained. Of these, 81 (5.6%) were vanA VRE positive and 207 (14.3%) vanB VRE positive. There was no significant change in the incidence of vanB VRE whereas vanA VRE incidence peaked in October 2015 at 21 (11.3%) and then dropped to zero within the same timeframe.

Despite there being uniform management strategies implemented, there were distinct differences in the way in which each VRE type responded. This suggests that vanA VRE was amenable to control interventions and whereas vanB VRE was not.

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