Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-24T11:59:54.741Z Has data issue: false hasContentIssue false

The Epidemiology of Fecal Carriage of Vancomycin-Resistant Enterococci

Published online by Cambridge University Press:  02 January 2015

Abstract

An outbreak of vancomycin-resistant enterococci (VRE) began at the University of Massachusetts Medical Center in May 1993. As of September 1995, we had a total of 253 patients infected or colonized with VRE, with consequent increasing demand for private rooms. We analyzed results of surveillance cultures for VRE of 49 patients known to be colonized or infected with VRE. Of these, 34 (70%) were classified as persistent carriers, defined as patients with at least three consecutively positive cultures from any site taken over at least a 2-week period. The length of carriage varied from 19 to 303 days (median, 41 days); 11 patients were converters, defined as patients with three consecutive negative cultures from all previously colonized sites taken over a 3-week period. These patients were free of VRE for 39 to 421 days (median, 142 days). Four were recolonizers after they were documented to be clear of VRE for 33 to 106 days. VRE carriage tends to be prolonged, and hospitalization of patients with VRE will require continued isolation and contact precautions for control of transmission.

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, AHC, Collins, CH, Naidoo, J, George, RC. Vancomycin-resistant enterococci. Lancet 1988;1:5758.Google Scholar
2.Karanfil, LV, Murphy, M, Josephson, A, et al.A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195200.Google Scholar
3.Rubin, LG, Tucci, V, Ceranado, E, Eliopoulos, G, Isenberg, HD. Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700705.Google Scholar
4.Livornese, LL, Dias, J, Samel, C, et al.Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112116.Google Scholar
5.Handwerger, S, Raucher, B, Altarac, D, et al.Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin and gentamicin. Clin Infect Dis 1993;16:750755.Google Scholar
6.Boyle, JF, Soumakis, SA, Rendo, A, et al.Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin, penicillin and gentamicin. J. Clin Microbiol 1993;31:12801285.Google Scholar
7.Frieden, TR, Munsiff, SS, Low, DE, et al.Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:7679.Google Scholar
8.Boyce, JM, Opal, SM, Chow, JW, et al.Outbreak ofb multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:11481153.Google Scholar
9.Montecalvo, MA, Gedris, C, Issah, A, et al.Outbreak of vancomycin-resistant Enterococcus faecalis in an adult oncology unit. In: Proceedings and Abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology; 05 1992. Abstract 1169.Google Scholar
10.Glenn Morris, J, Shay, DK, Hebden, JN, et al.Enterococci resistant to multiple antimicrobial agents, including vancomycin. Establishment of endemicity in a university medical center, Ann Intern Med 1995;123:250259.Google Scholar
11.Centers for Disease Control and Prevention. Nosocomial enterococcus resistant to vancomycin-United States, 1989-1993. MMWR 1993;42:597599.Google Scholar
12.Martone, WJ. Vancomycin-resistant enterococci: an update. State-of-the-art minilecture. Program of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy 1995:26.Google Scholar
13.Green, M, Barbadora, K, Michaels, M. Recovery of vancomycin-resistant gram-negative cocci from pediatric liver transplant recipients. J Clin Microbiol 1991;29:25032506.Google Scholar
14.Kamitsuka, PF, Lim, PL, Skolnik, A, et al.Duration of colonization with vancomycin-resistant Enterococcus faecium (VRE). Fourth Annual Meeting of the Society of Hospital Epidemiology of America; New Orleans, LA; 03 20-22, 1994. Abstract 30.Google Scholar
15.Linden, P, Pasculler, AW, Kramer, DJ, Kusner, S, Manez, R. The duration of fecal carriage of vancomycin-resistant Enterococcus faecium (VREF). The 34th Interscience Conference on Antimicrobial Agents and Chemotherapy; Orlando, FL; 10 4-7, 1994. Abstract J150.Google Scholar
16.Polish, L, Hebden, J, Shay, D, Jarvis, W, Schwalbe, R, Morris, JG Jr.Duration of fecal carriage of vancomycin-resistant enterococcus (VRE) in ICU patients.The 35th Interscience Conference on Antimicrobial Agents and Chemotherapy; San Francisco, CA; 09 17-20, 1995. Abstract J37.Google Scholar
17.Henning, K, Boone, JN, Brown, AE, Wollner, N, DeLencastre, H, Armstrong, D. Stool surveillance for vancomycin-resistant Enterococcus faecium (VREF) on a pediatric oncology ward: duration of shedding and incidence of clinical infections. The 35th Interscience Conference on Antimicrobial Agents and Chemotherapy; San Francisco, CA; 09 17-20, 1995. Abstract J38.Google Scholar
18.Montecalvo, MA, de Lencastre, H, Gedris, H, et al.Natural history of colonization with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1995;16:680685.Google Scholar
19.Hospital Infection Control Practices Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105113.Google Scholar