Rapid Dissemination of β-Lactamase–Producing, Aminoglycoside-ResistantEnterococcus faecalisamong Patients and Staff on an Infant–Toddler Surgical Ward

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Abstract
ALTHOUGH enterococci are normal inhabitants of the gastrointestinal and female genital tracts, they are now recognized as formidable pathogens in hospitalized patients.1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Many patients become infected with their own strains of enterococci after they are admitted to the hospital,18 but nosocomial transmission occurs as well.19 , 20 Recently, strains of enterococci with high-level resistance (>500 to >2000 μg per milliliter) to gentamicin and other aminoglycosides have been detected in hospitals around the world,8 , 9 , 19 20 21 22 23 reaching epidemic proportions in some institutions. Bactericidal synergism with penicillins or vancomycin is not observed with these strains, considerably complicating therapy. A few isolated aminoglycoside-resistant strains of Enterococcus faecalis (Streptococcus faecalis) have been reported that also produce β-lactamases,24 , 25 further narrowing the therapeutic options. In this report we describe the rapid spread of a multiply resistant strain of E. faecalis on an infant–toddler surgical ward and identify the risk factors for nosocomial colonization; our observations include the surprising finding that a nurse who carried the organism in her gastrointestinal tract and on her hands was involved in sustaining the outbreak.