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Hospital outbreak caused by linezolid resistant Enterococcus faecium in Upper Austria

  • Kerschner, Heidrun1
  • Cabal, Adriana2, 3
  • Hartl, Rainer1
  • Machherndl-Spandl, Sigrid4
  • Allerberger, Franz2
  • Ruppitsch, Werner2
  • Apfalter, Petra1
  • 1 Institute for Hygiene, Microbiology and Tropical Medicine, Ordensklinikum Linz Elisabethinen, National Reference Center for Antimicrobial Resistance and Nosocomial Infections, Fadingerstrasse 1, Linz, 4020, Austria , Linz (Austria)
  • 2 Institute of Medical Microbiology and Hygiene, AGES - Austrian Agency for Health and Food Safety, Waehringerstrasse 25a, Vienna, 1090, Austria , Vienna (Austria)
  • 3 European Centre for Disease Prevention and Control (ECDC), European Public Health Microbiology Training Programme (EUPHEM), Stockholm, Sweden , Stockholm (Sweden)
  • 4 Department of Internal Medicine 1, Ordensklinikum Linz Elisabethinen, Fadingerstrasse 1, Linz, 4020, Austria , Linz (Austria)
Published Article
Antimicrobial Resistance & Infection Control
BioMed Central
Publication Date
Sep 09, 2019
DOI: 10.1186/s13756-019-0598-z
Springer Nature


BackgroundEnterococcus faecium is part of the human gastrointestinal flora but may act as opportunistic pathogen. Environmental persistence, high colonization capability and diverse intrinsic and acquired resistance mechanisms make it especially successful in nosocomial high-risk settings. In March 2014, an outbreak of Linezolid resistant Enterococcus faecium (LREfm) was observed at the hematooncology department of a tertiary care center in Upper Austria.MethodsWe report on the outbreak investigation together with the whole genome sequencing (WGS)-based typing results including also non-outbreak LREfm and susceptible isolates.ResultsThe 54 investigated isolates could be divided in six clusters based on cgMLST. Cluster one comprised LREfm isolates of genotype ST117 and CT24, which was identified as the causative clone of the outbreak. In addition, the detection of four other clusters comprising isolates originating from hematooncology patients but also at other hospitals, pointed to LREfm transmission between local healthcare facilities. LREfm patients (n = 36) were typically at risk for acquisition of nosocomial pathogens because of immunosuppression, frequent hospitalization and antibiotic therapies. Seven of these 36 patients developed LREfm infection but were successfully treated. After termination of the initial outbreak, sporadic cases occurred despite a bundle of applied outbreak control interventions.ConclusionsWGS proved to be an effective tool to differentiate several LREfm clusters in an outbreak. Active screening for LREfm is important in a high-risk setting such as hematooncology, where multiple introductions are possible and occur despite intensified infection control measures.

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