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. 2020 Sep 22;9(1):154.
doi: 10.1186/s13756-020-00820-8.

A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

Stefanie Kampmeier  1 , Hauke Tönnies  2 , Carlos L Correa-Martinez  2 , Alexander Mellmann  2 , Vera Schwierzeck  2
Affiliations

A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

Stefanie Kampmeier et al. Antimicrob Resist Infect Control. .

Abstract

Background: Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples.

Methods: Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST).

Results: WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies.

Conclusions: Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.

Keywords: COVID-19; Healthcare-associated infection; Intensive care unit; Nosocomial VRE cluster; Surface contamination; vanB.

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Conflict of interest statement

The authors declare that they have no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Timeline of the nosocomial VRE cluster. VRE positive patients are illustrated chronologically. Each line represents the timeline of a single patient. Grey shading of lines indicates duration of residence on ICU. VRE isolates derived from clinical (red) or screening samples (black) are shown as dots within the lines
Fig. 2
Fig. 2
Minimum spanning tree of detected E. faecium. Minimum spanning tree of 17 environmental (E) and five patient (P) vancomycin resistant (red) and vancomycin susceptible (blue) isolates illustrating their genotypic relationship based on up to 1423 cgMLST target genes, pairwise ignore missing values. Every circle represents one genotype, the size of circles correlates with the number of identical genotypes. Grey colouring indicates close genetic relation (≤ 3 alleles differing between two genotypes)
See this image and copyright information in PMC

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