Stool Carriage, Clinical Isolation, and Mortality During an Outbreak of Vancomycin-Resistant Enterococci in Hospitalized Medical and/or Surgical Patients

Abstract

During a nosocomial outbreak of infection due to vancomycin-resistant enterococci (VRE), rectal swabs that were collected weekly were used to identify and isolate VRE carriers. Over 6 months, 1,458 stool specimens from 724 high-risk patients were cultured, and 187 VRE isolates were recovered from 61 patients; 96% of the isolates were Enterococcus faecium. VRE tended to be isolated from clinical specimens from patients identified as VRE carriers by stool surveillance (P < .01). However, isolation of VRE from surveillance cultures preceded clinical isolation for only approximately 50% of the patients from whom a clinical VRE isolate was recovered. Mortality was greater (P < .05) among patients from whom a clinical VRE isolate was recovered than among patients from whom VRE was isolated only by stool surveillance. The mortality (1[17%] of 6) among patients for whom VRE was isolated from blood was similar to that (10 [27%] of 37) among patients for whom vancomycin-susceptible enterococcus was isolated from blood (P = .97). Despite prompt initiation of contact precautions for VRE carriers, the incidence of fecal carriage of VRE remained approximately 8% among this patient population for the 6-month period of the study.

Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in São Paulo, Brazil

“…Educational classes on the importance of VRE were given in group sessions, and guidelines were posted in each unit. We emphasize the growing importance of the vancomycin-resistant enterococci as nosocomial pathogens, causing, besides colonization, severe infections, such as bacteremias, urinary-tract and surgical-site infections [3,28]. The therapeutic arsenal presently available is quite scarce, with accounts of resistance to recently developed drugs (e.g.…”

Relationships between Enterococcal Virulence and Antimicrobial Resistance

“…Notably, enteric VRE colonization usually precedes infection (115). The lower intestinal tract is the most frequently colonized site, and persistent enteric colonization, especially among those with frequent hospital readmissions, may be a prominent VRE reservoir.…”

The Epidemiology and Control of VRE: Still Struggling to Come of Age

“…As in the first 5 years of the epidemic, 14 most investigators have not succeeded in recovering VRE from the hands of HCWs 16 or have recovered VRE on culture of hands from a very small percentage of HCWs. 26 Unlike the findings of the latter studies, Bonilla and colleagues recovered VRE from the hands of 13% to 41% of HCWs over 3 years in a long-term-care unit. 27 In a mathematical model of transmission dynamics, persistence, and the impact of infection control programs on VRE in an intensive care unit setting, Austin and colleagues showed that the prevalence of contamination of HCWs' hands was very low, even though the incidence may have been high, and offered this observation as an explanation for the low recovery of VRE from cultures of HCWs' hands.…”