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Volume 49, Number 5, October 2016

Identification of subclinical transmission of vancomycin-resistant enterococcus within an intensive care unit in Taiwan 

Sai-Cheong Lee, Chao-Wei Lee, Tsai-Chien Shih, Lai-Chu See, Chien-Ming Chu, Yu-Chih Liu


Corresponding author:

Corresponding author. Sai-Cheong Lee, Division of Infectious Diseases, Chang Gung Memorial Hospital, 222, Mai Chin Road, Keelung, Taiwan. 


Background and purpose: 

Colonization, infection, and clonal dissemination of vancomycin-resistant enterococcus (VRE) have been reported in the literature. We aimed to investigate the incidence rate of VRE acquisition and route of transmission of VRE within the medical intensive care unit (ICU) to prove whether subclinical transmission occurs in medical ICUs. 



Between March 1, 2012 and September 30, 2013, rectal cultures were obtained from all inpatients on admission and after admission to medical ICU. Strain types of VRE were determined by both multilocus sequence typing and pulsed-field gel electrophoresis.




A total of 66 of the 405 rectal swab surveillance cultures obtained from 46 inpatients were positive for VRE, among which 27 inpatients were culture-positive for VRE on admission to medical ICU, and 19 inpatients were initially culture-negative but converted to culture-positive after admission. All isolates carried vanA gene consisting of 51 Enterococcus gallinarum, 13 Enterococcus faecium, and two Eenterococcus casseliflavus. Of the 51 E. gallinarum isolates, 40 were type ST 341, seven were ST 252, two were ST 78, and two were ST 64. The Enterococcus spp., MLST and PFGE subtypes were almost similar among these two groups of inpatients. Linezolid and tigecycline were most active against VRE in vitro. 



Subclinical VRE cross transmission may occur in ICU. Active surveillance and maximal barrier precautions of VRE are required at ICU with high colonization rate of VRE and shall be beneficial.



Key words:

VRE, subclinical transmission, ICU