PMID- 11168032
OWN - NLM
STAT- MEDLINE
DCOM- 20010823
LR  - 20190921
IS  - 1198-743X (Print)
IS  - 1198-743X (Linking)
VI  - 6
IP  - 1
DP  - 2000 Jan
TI  - Vancomycin resistance emerging in a clonal outbreak caused by 
      ampicillin-resistant Enterococcus faecium.
PG  - 19-28
AB  - OBJECTIVES: To describe the first nosocomial outbreak of ampicillin-resistant 
      Enterococcus faecium (ARE) in Norway, where a few vancomycin-resistant strains 
      have also been identified. METHODS: All cases of ARE and vancomycin-resistant 
      Enterococcus faecium (VRE) diagnosed by the medical microbiological laboratories 
      in a region inhabited by approximately 1 million people were registered. Isolates 
      obtained during the period 1 January 1995 to 31 December 1996 were characterized 
      by pulsed field-gel electrophoresis and the clinical data were recorded. RESULTS: 
      One hundred and forty-nine patients (64 males, 85 females, mean age 70.5 years) 
      were infected with ARE. Isolates from 115 cases were genomically related to the 
      outbreak strain. Infections included bacteremia (14), wound infections (31), 
      urinary tract infections (97) and other infections (seven). Most had a severe 
      underlying disease and 93% of the patients had received antibiotics for a mean 
      time of 23 days. Twenty-four patients (16.1%) died during hospitalization. Four 
      infections were caused by a vanB-type VRE that was genomically related to the ARE 
      outbreak strain. The prescription rate for vancomycin was low, but an increase in 
      vancomycin use paralleled the appearance of VRE. The highest monthly incidence 
      rate was 2.5 per 1000 patient admissions in July 1996 declining to 0.5 in 
      December 1996. CONCLUSIONS: The first nosocomial outbreak caused by ARE was 
      observed in 1995 in Norway and is still ongoing. One year after the onset, VRE 
      occurred in wards which had a relatively high consumption of vancomycin.
FAU - Harthug, S
AU  - Harthug S
AD  - Department of Medicine, The Gade Institute, Haukeland University Hospital, 
      Bergen, Norway. stig.harthug@haukeland.no
FAU - Digranes, A
AU  - Digranes A
FAU - Hope, O
AU  - Hope O
FAU - Kristiansen, B E
AU  - Kristiansen BE
FAU - Allum, A G
AU  - Allum AG
FAU - Langeland, N
AU  - Langeland N
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Clin Microbiol Infect
JT  - Clinical microbiology and infection : the official publication of the European 
      Society of Clinical Microbiology and Infectious Diseases
JID - 9516420
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Penicillins)
RN  - 6Q205EH1VU (Vancomycin)
RN  - 7C782967RD (Ampicillin)
SB  - IM
MH  - Aged
MH  - Ampicillin/pharmacology
MH  - *Ampicillin Resistance
MH  - Anti-Bacterial Agents/pharmacology
MH  - Cross Infection/drug therapy/*epidemiology
MH  - *Disease Outbreaks
MH  - Electrophoresis, Gel, Pulsed-Field
MH  - Enterococcus faecium/*drug effects/genetics
MH  - Female
MH  - Genotype
MH  - Gram-Positive Bacterial Infections/drug therapy/*epidemiology
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Microbial Sensitivity Tests
MH  - Norway/epidemiology
MH  - Penicillins/pharmacology
MH  - Vancomycin/pharmacology
MH  - *Vancomycin Resistance
EDAT- 2001/02/13 11:00
MHDA- 2001/08/24 10:01
CRDT- 2001/02/13 11:00
PHST- 2001/02/13 11:00 [pubmed]
PHST- 2001/08/24 10:01 [medline]
PHST- 2001/02/13 11:00 [entrez]
AID - S1198-743X(14)63629-6 [pii]
AID - 10.1046/j.1469-0691.2000.00008.x [doi]
PST - ppublish
SO  - Clin Microbiol Infect. 2000 Jan;6(1):19-28. doi: 
      10.1046/j.1469-0691.2000.00008.x.