Ms. Barsha Baral1, Ms. Dorothy Ling1, Ms. Yvonne Hersusianto1
1Northern Health, Australia
Biography:
Barsha Baral is a Nurse Manger for Infection Prevention and Surveillance team at Northern Health. She has over 10 years of nursing experience. She worked across infection prevention in Australia and New Zealand.
Abstract:
Background
As part of the Victorian state-wide surveillance of vanA vancomycin resistant enterococci (VRE), an increase in the number of linezolid-resistant vanA VRE isolates was notified to our organization. There were six genomically related isolates sequence type (MLST) 817 with an uncommon optrA gene detected. Environmental transmission was hypothesised as the primary route of transmission.
Infection Control Actions
– Epidemiological investigation of all the notified cases
– Deep cleaning of wards implicated in epidemiological investigation (‘high-risk wards’)
– Microbiological environmental sampling
– Prospective patient surveillance screening in high-risk wards
– Review of current VRE cleaning policies and practices
– Targeted education to the nursing and cleaning staffs in high-risk wards
Results
Over four months period of contact tracing and case finding, an additional nine cases were identified.
In total, 15 isolates from patients and two isolates from environmental sampling were found to be genomically related on phylogenetic analysis.
Thirteen vanA VRE isolates carrying the optrA gene were tested resistant to linezolid on antimicrobial susceptibility testing while four vanA VRE isolates that did not carry the optrAgene tested susceptible to linezolid.
Conclusion
Linezolid-resistant vanA VRE has been rarely reported but has significant clinical implications. Phylogenetic analysis with additional epidemiological data assisted in the interpretation and understanding of the genomic relationships. Infection Control measures of early identification of cases and actions to break the chain of infection will help to prevent onward transmission to susceptible patients. Go hard and go early was our approach with this outbreak.