First outbreak of vancomycin-resistant Enterococcus in a haematology unit in Durban, South Africa

Figures & data

Figure 1: Timeline demonstrating day of isolation of VRE in relation to period of admission in the seven patients admitted to HU.

Table 1: Clinical and demographic data of 9 patients with VRE at IALCH

Patient No	Ward	Age	Sex	Clinical data	Sample (Date)	PFGE
1	HU	21	M	Acute lymphoblastic leukaemia	Urine (19 April 2011)	Closely related to Clusters A & B
2	HU	56	F	Acute myeloid leukaemia	Blood (2 August 2011)	A
3	HU	24	F	Acute promyelocytic leukaemia	Urine (17 August 2011)	ND^a
4	HU	48	F	Acute myeloid leukaemia	Blood (6 September 2011)	Unique
					Blood (9 September 2011)	B
5	HU	16	F	Acute myeloid leukaemia	Stool (14 September 2011)	ND
6	HU	15	F	Acute lymphoblastic leukaemia	Blood (15 October 2011)	A
7	HU	13	F	Acute lymphoblastic leukaemia	Stool (9 November 2011)	ND
8	Surgical ICU	59	M	Ca bladder with ileal conduit	Perit. Fluid (23 November 2011)	A
9	Cardiothoracic ICU	33	F	Double valve replacement	Urine (17 February 2012)	ND

^a ND=not done.

Table 2: Clinical and demographic data of 4 patients with VRE at private hosptials in KZN IALCH

Patient No	Hospital (ward)	Age	Sex	Clinical data	Sample (Date)	PFGE
10	Newcastle (ICU)	76	M	Unknown	Central venous catheter tip (2 September 2011)	A
11	Empangeni	73	F	Unknown	Vaginal swab (8 September 2011)	A
12	Newcastle	39	M	Unknown	Blood (30 September 2011)	A
13	Newcastle	31	F	Unknown	Urine (21 October 2011)	ND^a

^a ND=not done.

Table 3: Antimicrobial exposure and outcome in 13 patients with VRE

Patient No	Previous antimicrobial exposure (No. of days)	Treatment	Outcome
1	Nil	Not treated	Survived
2	Piperacillin/tazobactam (7)	Linezolid
	Amikacin (7)
3	Piperacillin/tazobactam (2)	Not treated	Survived
	Amikacin (2)
4	Vancomycin (20)	Linezolid	Survived
	Meropenem (20)
5	Vancomycin (7)	Not treated	Survived
	Meropenem (7)
	Piperacillin/tazobactam (1)
	Amikacin (1)
6	Vancomycin (16)	Linezolid	Demised
	Meropenem (16)
	Piperacillin/tazobactam (3)
	Amikacin (3)
7	Vancomycin (10)	Linezolid	Survived
	Meropenem (10)
	Piperacillin/tazobactam (2)
	Amikacin (2)
8	Vancomycin (18)	Linezolid	Survived
	Meropenem (7)
	Piperacillin/tazobactam (7)
	Ciprofloxacin(7)
9	Colistin(30)	Linezolid	Survived
	Meropenem(30)
10	NA^a	Not treated	Survived
11	NA	Not treated	Demised
12	NA	Linezolid	Survived
13	NA	Not treated	Survived

^a NA = not available.

Table 4: Results of PFGE of five environmental samples from HU

Sample	Date of specimen	PFGE result
Table	5 August 2011	A
Dripstand	5 August 2011	Closely related to Clusters A & B
Commode	10 September 2011	B
Door of patient 4	10 September 2011	A
Commode	10 September 2011	A

Figure 2: PFGE results of all VRE isolates tested.

Lane 2, commode; Lane 3, door of patient 4; lane 4, Patient 6 (blood culture); Lane 5, Patient 6 (CVP tip); Lane 6, table; Lane 7, Patient 4 (blood culture 6 September 2011); Lane 8, Patient 2; Lane 9, Patient 4 (blood culture- 9 September 2011); Lane 10, commode; Lane 11 dripstand; Lane 12, Patient 8, Lane 13, Patient 1; Lane 14, Patient 10; Lane 15, Patient 11; Lane 16, patient 12; Lanes 1 and 17 are molecular size markers