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

Published online by Cambridge University Press:  02 January 2015


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.

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

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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