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A 7-year study of the routes of nosocomial vancomycin-resistant Enterococcus (VRE) transmission in a single institute in Cambridge, United Kingdom, provides new information with important implications for hospital infection control. The study identified multiple routes of VRE introduction into the hospital followed by a complex network of organism transmission thereafter.  

These findings reinforce the importance of using active screening to detect VRE carriers in conjunction with infection control measures to prevent further transmission. Active screening as part of a broader infection prevention program can reduce the rates of VRE colonization and infection, which can lead to lower rates of infection such as seen in countries that implement this strategy, such as Finland and the Netherlands.

This study used patient admission and ward movement data along with advanced whole genome sequencing methods to track introduction and transmission of multiple VRE strains. More than 50% of isolates found in the study were highly related to at least one other isolate, highlighting the complexity of VRE transmission within the hospital. Given the data, the investigators concluded that targeted infection control interventions triggered only by outbreak investigations, without active screening, would only be partially effective in reducing VRE rates.

Active screening reduces the rates of VRE infection, and countries that implement this strategy (eg, Finland and the Netherlands) have considerably lower rates of VRE infection than the United Kingdom.”

VRE is a leading cause of healthcare-associated infections. These infections, compared with those caused by vancomycin-susceptible enterococci, have higher mortality rates and healthcare costs. Because it can often persist in hospital settings, vancomycin resistant strains of Enterococcus faecium is a particular challenge to eradicate. This challenge is compounded by a lack of active screening.

The report of their findings was published in Clinical Infectious Diseases.

KE Raven et al. Clinical Infectious Diseases 2017

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