Major article| Volume 41, ISSUE 9, P778-781, September 2013

Download started.


Low risk of apparent transmission of vancomycin-resistant Enterococci from bacteraemic patients to hospitalized contacts

Published:March 04, 2013DOI:


      Vancomycin-resistant enterococci (VRE) are primarily opportunistic pathogens with incalculable clinical significance. In addition, the effectiveness of isolation in VRE is often not easily assessed. The goals of this study were to estimate the transmissibility of VRE of patients with VRE bacteraemia to other hospitalized patients and to document reliable epidemiologic data on all VRE cases in a large health care center.


      A prospective survey on in-patients colonized and/or systemically infected with VRE was conducted at a 2,000-bed tertiary care university hospital in Germany. All roommates of VRE bacteraemia patients were analyzed. Pulsed-field gel electrophoresis was performed to assess clonal relatedness.


      16,507 Screening tests were performed on 9,258 patients, of which 560 tested positive for VRE (6.1%). Nineteen patients also suffered from VRE bacteraemia, an incidence of 3.4%. This cohort was multimorbid and had high rates of exposure to external risk factors (eg, previous hospital stay prior to admission, 78.9%). The transmission rate to contacts was low (3.5%). Contact time of negative contacts was significantly lower than that of VRE-positive contacts (19.3 hours vs 72.0 hours, respectively, P < .006).


      VRE bacteraemia was found exclusively in multimorbid patients, transmission occurred seldom, and average contact time of positive contacts was very high. The risk of transmission of VRE from bacteraemic patients to hospitalized contacts is low.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Werner G.
        • Coque T.M.
        • Hammerum A.M.
        • Hope R.
        • Hryniewicz W.
        • Johnson A.
        • et al.
        Emergence and spread of vancomycin resistance among enterococci in Europe.
        Euro Surveill. 2008; 13: 1-11
        • Frieden T.R.
        • Munsiff S.S.
        • Low D.E.
        • Willey B.M.
        • Williams G.
        • Faur Y.
        • et al.
        Emergence of vancomycin-resistant enterococci in New York City.
        Lancet. 1993; 342: 76-79
        • Hidron A.I.
        • Edwards J.R.
        • Patel J.
        • Horan T.C.
        • Sievert D.M.
        • Pollock D.A.
        • et al.
        NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007.
        Infect Control Hosp Epidemiol. 2008; 29: 996-1011
        • Arias C.A.
        • Murray B.E.
        The rise of the Enterococcus: beyond vancomycin resistance.
        Nat Rev Microbiol. 2012; 10: 266-278
        • Worth L.J.
        • Thursky K.A.
        • Seymour J.F.
        • Slavin M.A.
        Vancomycin-resistant Enterococcus faecium infection in patients with hematologic malignancy: patients with acute myeloid leukemia are at high-risk.
        Eur J Haematol. 2007; 79: 226-233
        • Russell D.L.
        • Flood A.
        • Zaroda T.E.
        • Acosta C.
        • Riley M.M.
        • Busuttil R.W.
        • et al.
        Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients.
        Am J Transplant. 2008; 8: 1737-1743
        • Dutka-Malen S.
        • Evers S.
        • Courvalin P.
        Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci by PCR.
        J Clin Microbiol. 1995; 33: 1434
        • Eigner U.
        • Holfelder M.
        • Oberdorfer K.
        • Betz-Wild U.
        • Bertsch D.
        • Fahr A.M.
        Performance of a matrix-assisted laser desorption ionization-time-of-flight mass spectrometry system for the identification of bacterial isolates in the clinical routine laboratory.
        Clin Lab. 2009; 55: 289-296
        • Murchan S.
        • Kaufmann M.E.
        • Deplano A.
        • de Ryck R.
        • Struelens M.
        • Zinn C.E.
        • et al.
        Harmonization of pulsed-field gel electrophoresis protocols for epidemiological typing of strains of methicillin-resistant Staphylococcus aureus: a single approach developed by consensus in 10 European laboratories and its application for tracing the spread of related strains.
        J Clin Microbiol. 2003; 41: 1574-1585
        • Tenover F.C.
        • Arbeit R.D.
        • Goering R.V.
        • Mickelsen P.A.
        • Murray B.E.
        • Persing D.H.
        • et al.
        Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing.
        J Clin Microbiol. 1995; 33: 2233-2239
        • Armonk N.Y.
        • IBM Corporation
        IBM SPSS Statistics Base 20, Handbook.
        IBM, 2011
        • Falk P.S.
        • Winnike J.
        • Woodmansee C.
        • Desai M.
        • Mayhall C.G.
        Outbreak of vancomycin-resistant enterococci in a burn unit.
        Infect Control Hosp Epidemiol. 2000; 21: 575-582
        • Song J.Y.
        • Cheong H.J.
        • Jo Y.M.
        • Choi W.S.
        • Noh J.Y.
        • Heo J.Y.
        • et al.
        Vancomycin-resistant Enterococcus colonization before admission to the intensive care unit: a clinico-epidemiologic analysis.
        Am J Infect Control. 2009; 37: 734-740
        • Haas E.J.
        • Zaoutis T.E.
        • Prasad P.
        • Li M.
        • Coffin S.E.
        Risk factors and outcomes for vancomycin-resistant enterococcus bloodstream infection in children.
        Infect Control Hosp Epidemiol. 2010; 31: 1038-1042
        • Tacconelli E.
        • Karchmer A.W.
        • Yokoe D.
        • D’Agata E.M.
        Preventing the influx of vancomycin-resistant enterococci into health care institutions, by use of a simple validated prediction rule.
        Clin Infect Dis. 2004; 39: 964-970
        • Mellmann A.
        • Orth D.
        • Dierich M.P.
        • Allerberger F.
        • Klare I.
        • Witte W.
        Nosocomial cross transmission as a primary cause of vancomycin-resistant enterococci in Austria.
        J Hosp Infect. 2000; 44: 281-287
        • Klare I.
        • Werner G.
        • Witte W.
        Enterokokken mit vancomycin-resistenz in deutschen Krankenhäusern 2008/2009.
        Epidemiologisches Bulletin: Robert Koch-Institute, Berlin, Germany2010 (p. 14)
        • Pearson J.
        • Christiansen K.
        • Turnidge J.
        • Bell J.
        • Gottlieb T.
        • George N.
        Vancomycin-resistant enterococci in Australia: results of the AGAR surveys 1995 to 2010. Antimicrobials 2011.
        Australian Group for Antimicrobial Resistance (AGAR), Melbourne, Australia2011
        • Schouten M.A.
        • Hoogkamp-Korstanje J.A.
        • Meis J.F.
        • Voss A.
        Prevalence of vancomycin-resistant enterococci in Europe.
        Eur J Clin Microbiol Infect Dis. 2000; 19: 816-822
        • Goossens H.
        • Jabes D.
        • Rossi R.
        • Lammens C.
        • Privitera G.
        • Courvalin P.
        European survey of vancomycin-resistant enterococci in at-risk hospital wards and in vitro susceptibility testing of ramoplanin against these isolates.
        J Antimicrob Chemother. 2003; 51: iii5-12
        • Martinez J.A.
        • Ruthazer R.
        • Hansjosten K.
        • Barefoot L.
        • Snydman D.R.
        Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit.
        Arch Intern Med. 2003; 163: 1905-1912
        • Hota B.
        Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection?.
        Clin Infect Dis. 2004; 39: 1182-1189
        • Hachem R.
        • Graviss L.
        • Hanna H.
        • Arbuckle R.
        • Dvorak T.
        • Hackett B.
        • et al.
        Impact of surveillance for vancomycin-resistant enterococci on controlling a bloodstream outbreak among patients with hematologic malignancy.
        Infect Control Hosp Epidemiol. 2004; 25: 391-394
        • Hayden M.K.
        • Bonten M.J.
        • Blom D.W.
        • Lyle E.A.
        • van de Vijver D.A.
        • Weinstein R.A.
        Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures.
        Clin Infect Dis. 2006; 42: 1552-1560
        • Cepeda J.A.
        • Whitehouse T.
        • Cooper B.
        • Hails J.
        • Jones K.
        • Kwaku F.
        • et al.
        Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study.
        Lancet. 2005; 365: 295-304
        • Kypraios T.
        • O’Neill P.D.
        • Huang S.S.
        • Rifas-Shiman S.L.
        • Cooper B.S.
        Assessing the role of undetected colonization and isolation precautions in reducing methicillin-resistant Staphylococcus aureus transmission in intensive care units.
        BMC Infect Dis. 2010; 10: 29
        • Huskins W.C.
        • Huckabee C.M.
        • O’Grady N.P.
        • Murray P.
        • Kopetskie H.
        • Zimmer L.
        • et al.
        Intervention to reduce transmission of resistant bacteria in intensive care.
        N Engl J Med. 2011; 364: 1407-1418
        • Tschudin Sutter S.
        • Frei R.
        • Dangel M.
        • Gratwohl A.
        • Bonten M.
        • Widmer A.F.
        Not all patients with vancomycin-resistant enterococci need to be isolated.
        Clin Infect Dis. 2010; 51: 678-683
        • Zhu W.
        • Murray P.R.
        • Huskins W.C.
        • Jernigan J.A.
        • McDonald L.C.
        • Clark N.C.
        • et al.
        Dissemination of an Enterococcus Inc18-Like vanA plasmid associated with vancomycin-resistant Staphylococcus aureus.
        Antimicrob Agents Chemother. 2010; 54: 4314-4320
        • Zhu W.
        • Clark N.C.
        • McDougal L.K.
        • Hageman J.
        • McDonald L.C.
        • Patel J.B.
        Vancomycin-resistant Staphylococcus aureus isolates associated with Inc18-like vanA plasmids in Michigan.
        Antimicrob Agents Chemother. 2008; 52: 452-457
        • de Niederhausern S.
        • Bondi M.
        • Messi P.
        • Iseppi R.
        • Sabia C.
        • Manicardi G.
        • et al.
        Vancomycin-resistance transferability from VanA enterococci to Staphylococcus aureus.
        Curr Microbiol. 2011; 62: 1363-1367
        • McNeil S.A.
        • Malani P.N.
        • Chenoweth C.E.
        • Fontana R.J.
        • Magee J.C.
        • Punch J.D.
        • et al.
        Vancomycin-resistant enterococcal colonization and infection in liver transplant candidates and recipients: a prospective surveillance study.
        Clin Infect Dis. 2006; 42: 195-203
        • Mattner F.
        • Bange F.C.
        • Meyer E.
        • Seifert H.
        • Wichelhaus T.A.
        • Chaberny I.F.
        Preventing the spread of multidrug-resistant gram-negative pathogens: recommendations of an expert panel of the german society for hygiene and microbiology.
        Dtsch Arztebl Int. 2012; 109: 39-45