Vancomycin‐resistant Enterococcus outbreak in a pre‐ and post‐cardiothoracic transplant population: Impact of discontinuing multidrug‐resistant organism surveillance during the coronavirus disease 2019 pandemic

• DOI: 10.1111/tid.13972
• Publication Date: 2022-09-28T12:19:10Z
• Authors: Shardul N. Rathod; Laura Bardowski; Isabella Tse; Andrei Churyla; Monica Fiehler; Michael Malczynski; Chao Qi; Sajal D. Tanna; Christine Bulger; Abbas Al‐Qamari; Robin Oakley; Teresa R. Zembower
• Keywords: 0301 basic medicine; Cross Infection; Enterococcus faecium; COVID-19; Anti-Bacterial Agents; Vancomycin-Resistant Enterococci; Disease Outbreaks; 3. Good health; 03 medical and health sciences; Vancomycin; Drug Resistance, Multiple, Bacterial; Humans; Pandemics; Gram-Positive Bacterial Infections

AbstractIntroductionMany institutions suspended surveillance and contact precautions for multidrug‐resistant organisms (MDROs) at the outset of the coronavirus disease 2019 (COVID‐19) pandemic due to a lack of resources. Once our institution reinstated surveillance in September 2020, a vancomycin‐resistant Enterococcus (VRE) faecium outbreak was detected in the cardiothoracic transplant units, a population in which we had not previously detected outbreaks.MethodsAn outbreak investigation was conducted using pulsed‐field gel electrophoresis for strain typing and electronic medical record review to determine the clinical characteristics of involved patients. The infection prevention (IP) team convened a multidisciplinary process improvement team comprised of IP, cardiothoracic transplant nursing and medical leadership, environmental services, and the microbiology laboratory.ResultsBetween December 2020 and March 2021, the outbreak involved thirteen patients in the cardiothoracic transplant units, four index cases, and nine transmissions. Of the 13, seven (54%) were on the transplant service, including heart and lung transplant recipients, patients with ventricular assist devices, and a patient on extracorporeal membrane oxygenation as a bridge to lung transplantation. Four of 13 (31%) developed a clinical infection.DiscussionCardiothoracic surgery/transplant patients may have a similar risk for VRE‐associated morbidity as abdominal solid organ transplant and stem cell transplant patients, highlighting the need for aggressive outbreak management when VRE transmission is detected. Our experience demonstrates an unintended consequence of discontinuing MDRO surveillance in this population and highlights a need for education, monitoring, and reinforcement of foundational infection prevention measures to ensure optimal outcomes. image