Hostname: page-component-7479d7b7d-m9pkr Total loading time: 0 Render date: 2024-07-15T15:22:29.090Z Has data issue: false hasContentIssue false

Vancomycin-Resistant Enterococci in Stool Specimens Submitted for Clostridium difficile Cytotoxin Assay

Published online by Cambridge University Press:  02 January 2015

Abstract

The prevalence of, and clinical risk factors associated with, vancomycin-resistant enterococcal colonization were investigated in patients suspected of having Clostridium difficile infection. Stools submitted for C difficile cytotoxin testing were screened for vancomycin-resistant enterococci (VRE). Isolates were speciated and characterized further by antibiotic susceptibility testing, DNA fingerprinting, and DNA:DNA hybridization for detection of specific vancomycin resistance genes. Of the 79 evaluable patients identified during a 3-month period, 16.5% were VRE-positive. The VRE isolates were genetically heterogeneous, although all carried the vanA gene. DNA fingerprinting data suggest that patient-to-patient transmission occurred, implicating colonized patients as potential reser voirs for VRE transmission. A positive C difficile cytotoxin assay and diabetes mellitus were the only identifiable risk factors associated with VRE colonization. Patients at risk for C difficile infection therefore may serve as reser voirs for VRE.

Type
Concise Communications
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Uttley, AH, Collins, CH, Naidoo, J, George, RC. Vancomycin-resistant enterococci. Lancet 1988;1:5758.CrossRefGoogle ScholarPubMed
2. Uttley, AH, George, RC, Naidoo, J, et al. High-level vancomycin-resistant enterococci causing hospital infections. Epidemiol Infect 1989;103:173181.CrossRefGoogle ScholarPubMed
3. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597599.Google Scholar
4. Handwerger, S, Raucher, B, Altarac, D, et al. Nosocomial out-break due to Enterococcus faecium highly resistant to van-comycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750755.CrossRefGoogle Scholar
5. Goldman, WM, Avicolli, AS, Lutwick, S. N Engl J Med 1994;330:1775. Letter.CrossRefGoogle Scholar
6. Facklam, RR, Collins, MD. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol 1989;27:731734.CrossRefGoogle ScholarPubMed
7. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests for Bacteria That Grow Aerobically. 3rd ed. Villanova, PA: NCCLS; 1993. Approved standard M7A3;13(25).Google Scholar
8. Smith, CL, Cantor, CR. Purification, specific fragmentation, and separation of large DNA molecules. Methods Enzymol 1981;155:449467.CrossRefGoogle Scholar
9. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.CrossRefGoogle ScholarPubMed
10. Sambrook, J, Fritsch, EF, Maniatis, T. Molecular Cloning: A Laboratory Manual. 2nd ed. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory; 1989.Google Scholar
11. Preventing the spread of vancomycin resistance—report from the Hospital Infection Control Practices Advisory Committee. Federal Register 1994;59(94):2575825763.Google Scholar