Caracterización clínica y molecular de un brote por enterococcus faecium resistente a la vancomicina en el Hospital Universitario Mayor-Méderi, Bogotá 2016

Abstract

Introduction. This study describes the dissemination pattern of the vancomycin-resistant Enterococcus faecium between April to May 2016, in the highest installed capacity hospital in Colombia, integrating clinical and molecular strategies. Methods A Time-Place-Clonality algorithm was adapted to estimate the transmission routes, through the multi-locus variable number tandem repeats analysis (MLVA) for the clonal identification and the internal transfer route of the patients during their hospital stay. Results. Due to difficulties in reproducibility for VNTR-2, the cluster analysis of 5 VNTRs was the method of choice to determine clonality. Four clonal profiles were identified among the 33 isolates recovered, 13 of which were obtained from outbreak patients. The profiles most frequently identified during the outbreak were A and B: 9 and 2 patients, respectively (69.2% and 15.4%). In most of cases, patients shared a floor (indirect contact), but not a room or hospitalization bed (direct contact), which suggests a cross transmission by health-care providers. Discussion. After the analysis of the results, we concluded that the outbreak had a dynamic, multiple source and polyclonal behavior, with an indirect transmission route through the health personnel. Among the main benefits obtained locally, were the optimization of resources in infection control and the implementation of more effective strategies in the prevention of future outbreaks, individualized to the institution.