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The Epidemiology of Vancomycin-Resistant Enterococcus Colonization in a Medical Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015


David K. Warren
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Marin H. Kollef
Affiliation:
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
Sondra M. Seiler
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Scott K. Fridkin
Affiliation:
Epidemiology and Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri

Abstract

Objective:

To determine the epidemiology of colonization with vancomycin-resistant Enterococcus (VRE) among intensive care unit (ICU) patients.

Design:

Ten-month prospective cohort study.

Setting:

A 19-bed medical ICU of a 1,440-bed teaching hospital.

Methods:

Patients admitted to the ICU had rectal swab cultures for VRE on admission and weekly thereafter. VRE-positive patients were cared for using contact precautions. Clinical data, including microbiology reports, were collected prospectively during the ICU stay.

Results:

Of 519 patients who had admission stool cultures, 127 (25%) had cultures that were positive for VRE. Risk factors for VRE colonization identified by multiple logistic regression analysis were hospital stay greater than 3 days prior to ICU admission (adjusted odds ratio [AOR], 3.6; 95% confidence interval [CI95], 2.3 to 5.7), chronic dialysis (AOR, 2.4; CI95, 1.2 to 4.5), and having been admitted to the study hospital one to two times (AOR, 2.3; CI95,1.4 to 3.8) or more than two times (AOR, 6.5; CI95, 3.7 to 11.6) within the past 12 months. Of the 352 VRE-negative patients who had one or more follow-up cultures, 74 (21%) became VRE positive during their ICU stay (27 cases per 1,000 patient-ICU days).

Conclusion:

The prevalence of VRE culture positivity on ICU admission was high and a sizable fraction of ICU patients became VRE positive during their ICU stay despite contact precautions for VRE-positive patients. This was likely due in large part to prior VRE exposures in the rest of the hospital where these control measures were not being used.


Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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