First outbreak of vancomycin-resistant Enterococcus in a haematology unit in Durban, South Africa

Abstract

Vancomycin resistant enterococci (VRE) are increasingly important causes of morbidity and mortality in developed countries. Although VRE is a significant cause of nosocomial sepsis in these countries, limited data is available on the role that this pathogen plays in South Africa. We describe the demographic, clinical and genotypic data of seven patients involved in the first outbreak of VRE in a haematology unit at a tertiary hospital in Durban and also report the isolation of VRE from six patients from other wards in this hospital and from hospitals outside Durban. The outbreak occurred from 19 April 2011 to 9 November 2011. Pulse Field Gel Electrophoresis (PFGE) was conducted on 15 clinical and environmental samples. Two closely-related clusters and a unique strain were identified from both clinical and environmental samples. Furthermore, the predominant cluster was found in other hospitals in KwaZulu-Natal. After infection control practices were reinforced, the outbreak terminated. Our study highlights that VRE is an emerging pathogen in KZN, especially in high risk units. The environment serves as a significant reservoir of VRE and infection control strategies should be directed to reduce the transmission of VRE from environmental sources.

Keywords

• enterococci
• infection control
• outbreak
• resistance
• vancomycin