{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:03:52Z","timestamp":1790687032941,"version":"4.1.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T00:00:00Z","timestamp":1613606400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T00:00:00Z","timestamp":1613606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Antimicrob Resist Infect Control"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The emergence of vancomycin resistant enterococci poses a major problem in healthcare settings. Here we describe a hospital-wide outbreak of vancomycin-resistant\n                      <jats:italic>Enterococcus faecium<\/jats:italic>\n                      in a general hospital in The Netherlands in the period December 2014\u2013February 2017. Due to late detection of the outbreak, a large cohort of approximately 25,000 (discharged) patients was classified as \u2018VRE suspected\u2019. Hereupon a mitigated screening and isolation policy, as compared with the national guideline, was implemented to control the outbreak.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>After the outbreak was identified, a screening policy consisting of a single rectal swab culture (with enrichment broth) to discontinue isolation and removing \u2018VRE suspected\u2019 label in the electronic patient files for readmitted VRE suspected patients, was implemented. In addition to the on admission screening, periodic hospital-wide point prevalence screening, measures to improve compliance with standard infection control precautions and enhanced environmental cleaning were implemented to control the outbreak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between September 2014 and February 2017, 140 patients were identified to be colonised by\n                      <jats:italic>vanA<\/jats:italic>\n                      mediated vancomycin-resistant\n                      <jats:italic>Enterococcus faecium<\/jats:italic>\n                      (VRE\n                      <jats:italic>fm<\/jats:italic>\n                      ). Two of these patients developed bacteraemia. AFLP typing showed that the outbreak was caused by a single clone. Extensive environmental contamination was found in multiple wards. Within nine months after the detection of the outbreak no new VRE cases were detected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We implemented a control strategy based on targeted screening and isolation in combination with implementation of general precautions and environmental cleaning. The strategy was less stringent than the Dutch national guideline for VRE control. This strategy successfully controlled the outbreak, while it was associated with a reduction in the number of isolation days and the number of cultures taken.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13756-021-00906-x","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T11:02:26Z","timestamp":1613818946000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Management of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in a Dutch general hospital, 2014\u20132017: successful control using a restrictive screening strategy"],"prefix":"10.1186","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1101-4494","authenticated-orcid":false,"given":"Veronica","family":"Weterings","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"van Oosten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Nieuwkoop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolande","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Voss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"Wintermans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris","family":"van Lieshout","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Kluytmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacobien","family":"Veenemans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,18]]},"reference":[{"key":"906_CR1","volume-title":"Surveillance of antimicrobial resistance in Europe 2018","author":"European Centre for Disease Prevention and Control","year":"2019","unstructured":"European Centre for Disease Prevention and Control. Surveillance of antimicrobial resistance in Europe 2018. Stockholm: ECDC; 2019."},{"key":"906_CR2","unstructured":"Nethmap 2019. Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands in 2018. https:\/\/www.rivm.nl\/documenten\/nethmap-2019."},{"key":"906_CR3","unstructured":"Overzicht meldingen aan het signaleringsoverleg zorginfecties en antimicrobi\u00eble resistentie (SO-ZI\/AMR) ZI\/AMR) Tabel. Overzicht van meldingen aan het SO-ZI\/AMR die werden gemeld en\/of afgerond in 2018 en 2019 en eerder gepubliceerd in de tabellen van het Wekelijks overzicht. 2019;1\u20135. https:\/\/www.nvmm.nl\/media\/2910\/2018-2019-totaal-overzicht-van-meldingen-na-2019-07.pdf."},{"issue":"4","key":"906_CR4","doi-asserted-by":"publisher","first-page":"e216","DOI":"10.1016\/j.jhin.2018.02.016","volume":"100","author":"FNJ Frakking","year":"2018","unstructured":"Frakking FNJ, Bril WS, Sinnige JC, Klooster JEV, de Jong BAW, van Hannen EJ, et al. Recommendations for the successful control of a large outbreak of vancomycin-resistant Enterococcus faecium in a non-endemic hospital setting. J Hosp Infect. 2018;100(4):e216\u201325.","journal-title":"J Hosp Infect"},{"key":"906_CR5","unstructured":"Werkgroep Infectiepreventie. 2012. WIP-richtlijn BRMO (Bijzonder Resistente Micro-Organismen). http:\/\/www.rivm.nl\/Documenten_en_publicaties\/Professioneel_Praktisch\/Richtlijnen\/Infectieziekten\/WIP_Richtlijnen\/Actuele_WIP_Richtlijnen\/Ziekenhuizen\/WIP_richtlijn_BRMO_Bijzonder_Resistente_Micro_Organismen_ZKH."},{"key":"906_CR6","unstructured":"Sinnige JC, Willems RJL, Ruijs GJHM, Mascini E, Arends JP, Troelstra A. NVMM Guideline HRMO VRE. 2015. http:\/\/www.nvmm.nl\/media\/1049\/2015_hrmo_vre.pdf."},{"issue":"1","key":"906_CR7","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s13756-020-00730-9","volume":"9","author":"A Van Arkel","year":"2020","unstructured":"Van Arkel A, Willemsen I, Kilsdonk-Bode L, Vlamings-Wagenaars S, van Oudheusden A, De Waegemaeker P, et al. ATP measurement as an objective method to measure environmental contamination in 9 hospitals in the Dutch\/Belgian border area. Antimicrob Resist Infect Control. 2020;9(1):77. https:\/\/doi.org\/10.1186\/s13756-020-00730-9.","journal-title":"Antimicrob Resist Infect Control"},{"issue":"8","key":"906_CR8","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1007\/s10096-015-2401-2","volume":"34","author":"V Weterings","year":"2015","unstructured":"Weterings V, Zhou K, Rossen JW, van Stenis D, Thewessen E, Kluytmans J, et al. An outbreak of colistin-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to December 2013), with inter-institutional spread. Eur J Clin Microbiol Infect Dis. 2015;34(8):1647\u201355.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"12","key":"906_CR9","doi-asserted-by":"publisher","first-page":"3788","DOI":"10.1128\/JCM.01946-15","volume":"53","author":"M De Been","year":"2015","unstructured":"De Been M, Pinholt M, Top J, Bletz S, Mellmann A, Van Schaik W, et al. 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