Controlling outbreak of vancomycin-resistant Enterococcus faecium among infants caused by an endemic strain in adult inpatients

Tobias Pusch, Dale Kemp, Sylvia Trevino, Thomas Button, Pablo Sanchez, Rita Gander, Pranavi Sreeramoju

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Vancomycin-resistant Enterococcus faecium (VREfm) is commonly associated with hospital outbreaks and has been found to be associated with increased morbidity, mortality, length of stay, and health care costs. Methods: We sought to investigate and control an outbreak of VREfm in the neonatal intensive care unit (NICU) of a public academic hospital with a level III NICU. The index case was an infant in the NICU incidentally identified with urinary colonization with VREfm. Aggressive control measures were initiated promptly. Investigation included active surveillance cultures in infants, parents of colonized infants, and birth mothers of newborn admitted to NICU; molecular strain typing of available isolates of VREfm including adult inpatients; and medical record review. Results: After identification of index case, 13 additional infants were identified with VREfm colonization. Age at culture was 6 to 87 days; birth weight was 1,070 to 2,834 g. VREfm isolated from majority of infants (12/14 [85.7%]), the birth mother of a pair of colonized twins, and a pulse oximeter device used in adult inpatients belonged to a single strain. Outbreak control measures were successful in the NICU. The outbreak-causing strain was found to be endemic among adult inpatients. Adult patients with the outbreak-causing strain of VREfm were more likely to have received previous therapy with meropenem (Mann-Whitney 2-tailed P value =.038). VRE colonization was identified in 0.3% (1/310) of birth mothers with newborn admitted to NICU. Conclusion: An endemic strain of VREfm among adult inpatients was responsible for a subsequently controlled outbreak in the NICU.

Original languageEnglish (US)
Pages (from-to)51-56
Number of pages6
JournalAmerican Journal of Infection Control
Issue number1
StatePublished - Jan 2013


  • Enterococcus faecium
  • Infection control
  • Intensive care units
  • Neonatal
  • Outbreaks

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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