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Natural History of Colonization with Vancomycin-Resistant Enterococcus Faecium

Published online by Cambridge University Press:  02 January 2015

Marisa A. Montecalvo
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York
Herminia de Lencastre
Affiliation:
Laboratory of Microbiology, The Rockefeller University, New York, New York
Margaret Carraher
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York
Cheryl Gedris
Affiliation:
Department of Pathology, New York Medical College, Valhalla, New York
Marilyn Chung
Affiliation:
Laboratory of Microbiology, The Rockefeller University, New York, New York
Ken VanHorn
Affiliation:
Department of Pathology, New York Medical College, Valhalla, New York
Gary P. Wormser
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York

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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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