Page 5 - pest-POSTEN nr 3,1997

Side 5 -pest-POSTEN

"Helnorske" innlegg ved

37th Interscience Conference on

Antimicrobial Agents and

Chemotherapy.

("Halvnorske" innlegg: se side 9..)

patients with an average time of hospital stay of
43.5 days compared to 6.2 for all patients in the
J-34. Vancomycin Resistance Emerging hospital. Most of the infected patients had
in a Clonal Outbreak Caused by severe underlying disease (28 % malignancy, 21
Multiresistant Enterococcus faecium % cardiovascular disease, 21% infectious
disease. Ninety four percent had received
HARTHUG S., LANGELAND N., HARRIS K. antimicrobial chemotherapy for a mean time of
AND DIGRANES A. 21.4 days prior to the MRE infection. The
Haukeland Univ. Hospital, Bergen, Norway.
average number of antmicrobial agents
The first nosocomial outbreak of multiresistant prescribed was 2.6. Forty seven percent had
Enterococcus faecium (MRE) appeared in a received cephalosporins, 37% penicillins, 32 %
1,100 bed Norwegian University Hospital. One aminoglycosides, 25 % fluoroquinolones and 7
hundred and forty seven patients (63 male 84 % glycopeptides. Fifteen (16 %) patients died
female, mean age 70.4 years) were infected by during hospital stay. The infection may have
MRE in the period January 1, 1995 through attributed to death in 5 cases. Forty six percent
of all cases were found in 3 wards where the
fecal carrier rate was 20% compared to zero in
all other wards examined. The index case was
found in the ICU. The outbreak spread mainly in
other wards. Four cases of infection caused by
vancomycin resistant E faecium (VRE) were
found, three of these in the high prevalence
wards. The VRE isolates were identical or
closely related to the MRE outbreak strain. The
VanB gene was detected by PCR for all VRE
isolates. The prescription rate for vancomycin
was low (0.032 defined daily doses per patient).
However, a marked increase in vancomycin use
in some wards paralleled the appearance of
VRE. Prophylactic precautions were taken as
Stig Harthug i dyp konsentrasjon. Norske recommended by the Hospital Infection Control
enterokokker vakte vel ingen stor oppsikt, Pracices Advisory Committee. The highest
- men et solid abeid var det likevel. monthly incidence rate was 2.5 per 1,000 patient
admissions in July 1996 declining to 0.5 in
December 1996. In conclusion, the first
December 31, 1996. Altogether 26 different outbreak caused by MRE in Norway was
patterns were found by pulsed field gel observed in our hospital in 1995 and 1996. VRE
electrophoresis. Isolates from 107 cases were emerged during the outbreak with identical or
identical or closely related to the outbreak strain. closely related strains to the MRE outbreak
Of these, 7 caused bacteriemia, 28 wound strain. The data suggest that VRE appeared in an
infections, 69 urinary tract infections and 3 other MRE epidemic when vancomycin use was
infections. One hundred and three patients were sufficiently high.
hospitalized. Clinical data were available for 92