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A nonclonal outbreak of vancomycin-sensitive Enterococcus faecalis bacteremia in a neonatal intensive care unit

Published online by Cambridge University Press:  05 August 2019

Despina Kotsanas ,
Kenneth Tan ,
Carmel Scott ,
Britta Baade ,
Michaela Hui Ling Cheng ,
Zien Vanessa Tan ,
Jacqueline E. Taylor ,
Jason C. Kwong ,
Torsten Seemann  and
Geoffrey W. Coombs
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Despina Kotsanas*
Affiliation:
Monash Infectious Diseases, Monash Medical Centre, Clayton, Victoria, Australia
Kenneth Tan
Affiliation:
Monash Newborn, Monash Children’s Hospital, Clayton, Victoria, Australia Department of Paediatrics, Monash University, Clayton, Victoria, Australia
Carmel Scott
Affiliation:
Infection Control, Monash Medical Centre, Clayton, Victoria, Australia
Britta Baade
Affiliation:
Monash Newborn, Monash Children’s Hospital, Clayton, Victoria, Australia
Michaela Hui Ling Cheng
Affiliation:
Department of Paediatrics, Monash University, Clayton, Victoria, Australia
Zien Vanessa Tan
Affiliation:
Department of Paediatrics, Monash University, Clayton, Victoria, Australia
Jacqueline E. Taylor
Affiliation:
Monash Newborn, Monash Children’s Hospital, Clayton, Victoria, Australia
Jason C. Kwong
Affiliation:
Department of Microbiology and Immunology, The University of Melbourne, Parkville, Victoria, Australia
Torsten Seemann
Affiliation:
Department of Microbiology and Immunology, The University of Melbourne, Parkville, Victoria, Australia
Geoffrey W. Coombs
Affiliation:
Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
Benjamin P. Howden
Affiliation:
Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
Rhonda L. Stuart
Affiliation:
Monash Infectious Diseases, Monash Medical Centre, Clayton, Victoria, Australia Department of Medicine, Monash University, Victoria, Australia
*
Author for correspondence: Despina Kotsanas, Monash Infectious Diseases, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia. E-mail: [email protected]
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Abstract

Objective:

To describe an outbreak of bacteremia caused by vancomycin-sensitive Enterococcus faecalis (VSEfe).

Design:

An investigation by retrospective case control and molecular typing by whole-genome sequencing (WGS).

Setting:

A tertiary-care neonatal unit in Melbourne, Australia.

Methods:

Risk factors for 30 consecutive neonates with VSEfe bacteremia from June 2011 to December 2014 were analyzed using a case control study. Controls were neonates matched for gestational age, birth weight, and year of birth. Isolates were typed using WGS, and multilocus sequence typing (MLST) was determined.

Results:

Bacteremia for case patients occurred at a median time after delivery of 23.5 days (interquartile range, 14.9–35.8). Previous described risk factors for nosocomial bacteremia did not contribute to excess risk for VSEfe. WGS typing results designated 43% ST179 as well as 14 other sequence types, indicating a polyclonal outbreak. A multimodal intervention that included education, insertion checklists, guidelines on maintenance and access of central lines, adjustments to the late onset sepsis antibiotic treatment, and the introduction of diaper bags for disposal of soiled diapers after being handled inside the bed, led to termination of the outbreak.

Conclusions:

Typing using WGS identified this outbreak as predominately nonclonal and therefore not due to cross transmission. A multimodal approach was then sought to reduce the incidence of VSEfe bacteremia.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1116 - 1122
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. Part of this study was presented in a poster at the Perinatal Society of Australia and New Zealand 2015 conference as preliminary case control findings: “Investigating Risk Factors for Enterococcal Bacteraemia in the NICU—A case control study,” on May 25, 2016, at Townsville, Queensland, Australia.

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