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Natural History of Colonization with Vancomycin-Resistant Enterococcus Faecium

  • Marisa A. Montecalvo (a1), Herminia de Lencastre (a2), Margaret Carraher (a1), Cheryl Gedris (a3), Marilyn Chung (a2), Ken VanHorn (a3) and Gary P. Wormser (a1)...

Abstract

Objective:

To determine the incidence, duration, and genetic diversity of colonization with vancomycin-resistant Enterococcus faecium (VREF).

Setting:

Oncology unit of a 650-bed university hospital.

Methods:

Surveillance perianal swab cultures were performed on admission and weekly. The molecular relatedness of VREF isolates was determined by pulsed-field gel electrophoresis and by the hybridization pattern of the vanA resistance determinant.

Results:

During 8 months of surveillance, the VREF colonization rate was 16.6 patients per 1,000 patient-hospital days, which was 10.6 times greater than the VREF infection rate. Eighty-six patients with VREF colonization were identified. Colonization persisted for at least 7 weeks in the majority of patients. Of 36 colonized patients discharged from the hospital and then readmitted, an average of 2½ weeks later, 22 (61%) patients still were colonized with VREF. Of the 14 patients who were VREF-negative at readmission, only three patients remained culture-negative throughout hospitalizations. PFGE demonstrated that colonization with the same VREF isolate may persist for at least 1 year, and patients may be colonized with more than one strain of VREF.

Conclusion:

VREF colonization is at least 10-fold more prevalent than infection among oncology patients. Colonization often persists throughout lengthy hospitalizations and may continue for long periods following hospitalization.

Copyright

Corresponding author

Macy Pavilion 209 SE, Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595

References

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Natural History of Colonization with Vancomycin-Resistant Enterococcus Faecium

  • Marisa A. Montecalvo (a1), Herminia de Lencastre (a2), Margaret Carraher (a1), Cheryl Gedris (a3), Marilyn Chung (a2), Ken VanHorn (a3) and Gary P. Wormser (a1)...

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