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(Chest. 2003;123:504S-518S.)
© 2003 American College of Chest Physicians

Vancomycin-Resistant Enterococci*

A Road Map on How To Prevent the Emergence and Transmission of Antimicrobial Resistance

Sylvain DeLisle, MD, MBA and Trish M. Perl, MD, MSc

* From the US Veterans Administration Medical Center (Dr. DeLisle), Departments of Internal Medicine and Physiology, Division of Pulmonary and Critical Care, University of Maryland, Baltimore; and Departments of Hospital Epidemiology and Medicine (Dr. Perl), Johns Hopkins Medicine and the Bloomberg School of Public Health and Hygiene, Johns Hopkins University, Baltimore, MD.

Correspondence to: Sylvain DeLisle, MD, MBA, 3D-122 VA Medical Center, 10 N. Greene St, Baltimore MD 21201; e-mail: sdelisle{at}umaryland.edu

Nosocomial acquisition of microorganisms resistant to multiple antibiotics represents a threat to patient safety. Here we review the mechanisms that have allowed highly resistant strains belonging to the Enterococcus genus to proliferate within our health-care institutions. These mechanisms indicate that decreasing the prevalence of resistant organisms requires active surveillance, adherence to vigorous isolation, hand hygiene and environmental decontamination measures, and effective antibiotic stewardship. We suggest how to tailor such a complex, multidisciplinary program to the needs of a particular health-care setting so as to maximize cost-effectiveness.

Key Words: antibiotic control • antibiotic management • antibiotic stewardship • enterococcus • infection control • resistance • review • surveillance • vancomycin • vancomycin-resistant enterococci




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