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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 ,
Herminia de Lencastre ,
Margaret Carraher ,
Cheryl Gedris ,
Marilyn Chung ,
Ken VanHorn  and
Gary P. Wormser
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
*
Macy Pavilion 209 SE, Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595
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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
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 12 , December 1995 , pp. 680 - 685
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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References

1.Schaberg, DR, Culver, DH, Gaynes, RP. Major trends in the microbial etiology of nosocomial infection. In: Martone, WJ, Garner, TS, eds. Proceedings of the Third Decennial International Conference on Nosocomial Infections. Am J Med 1991;91(3B):72–76.Google Scholar
2.Leclercq, R. Derlot, E, Duval, J, Courvalin, P. Plasmid mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988;319:157–161.Google Scholar
3.Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States 1989-1993. MMWR 1993;42:597–599.Google Scholar
4.Frieden, TR, Munsiff, SS, Low, DE, et al.Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76–79.Google Scholar
5.Noble, WC, Virani, Z, Cree, RGA. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett 1992;93:195–198.Google Scholar
6.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;13:195–200.Google Scholar
7.Rubin, LG, Tucci, V, Cercenado, E, Eliopoulos, G, Isenberg, HD. Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700–705.Google Scholar
8.Livornese, LL JrDias, S, Samuel, C, et al.Hospital acquired infection with vancomycin resistant Enterococcus faecium transmitted by electric thermometers. Ann Intern Med 1992;117:112–116.Google Scholar
9.Handwerger, S, Raucher, B, Altarac, D, et al.Nosocomial out-break due to Enterococcus faecium resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.Google Scholar
10.Montecalvo, MA, Horowitz, H, Gedris, C, et al.Outbreak of vancomycin, ampicillin, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.Google Scholar
11.Boyce, JM, Opal, SM, Chow, JW, et al.Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
12.Edmond, MD, Ober, JF, Weinbaum, DL, et al.Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1125–1133.Google Scholar
13.Hariharan, R, Nathan, C, McMahon, C, Tyrrell, J, Kabins, S, Weinstein, RA. Epidemiology of vancomycin-resistant enterococci (VRE) in ICU patients. Presented at the 33rd Interscience Conference of Antimicrobial Agents and Chemotherapy; 1993; New Orleans, LA. Abstract 849.Google Scholar
14.Hospital Infection Control Practices Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105–113.Google Scholar
15.Shay, DK, Maloney, SA, Montecalvo, MA, et al.Epidemiology and mortality risk of vancomycin-resistant enterococcal blood-stream infections. J Infect Dis 1995;172:993–1000.Google Scholar
16.Falkham, RR, Washington, JA II. Streptococcus and related catalase-negative gram-positive cocci. In: Balows, A, Hausler, WJ JrHerrmann, KL, Isenberg, HD, Shadomy, HJ, eds. Manual of Clinical Microbiology. 5th ed. Washington DC: American Society for Microbiology; 1991:238–257.Google Scholar
17.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. 5th ed. Villanova, PA: NCCLS; 1993. Approved standard. M2-A5.Google Scholar
18.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
19.De Lencastre, H, Couto, I, Santos, I, Melo-Cristino, J, Torres-Pereira, A, Tomasz, A. Methicillin-resistant Staphylococcus aureus disease in a Portuguese hospital: characterization of clonal types by a combination of DNA typing methods. Eur J Clin Microbiol Infect Dis 1994;13:64–73.Google Scholar
20.Murray, BE, Singh, KV, Heath, JD, Sharma, BR, Weinstock, GM. Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites. J Clin Microbiol 1990;28:2059–2063.Google Scholar
21.Goering, RV. Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 1993;14:595–600.Google Scholar
22.Handwerger, S, Skoble, J, Discotto, LF, Pucci, MJ. Heterogeneity of the vanA gene cluster in clinical isolates of enterococci from the Northeastern United States. Antimicrob Agents Chemother 1995;39:362–368.Google Scholar
23.Rohlf, FJ, Sokal, RR. Statistical Tables. 3rd ed. New York, NY: WH Freeman and Company; 1995.Google Scholar
24.Vasquez, A, Lutfey, M, Tucci, L, Serrell, F, Kreiswirth, B, Simberkoff, M. Clinical, microbiologic and epidemiologic evaluation of vancomycin-resistant Enterococcus faecium (VREF). Presented at the 33rd Interscience Conference of Antimicrobial Agents and Chemotherapy; 1993; New Orleans, LA. Abstract 852.Google Scholar
25.Linden, P, Pasculle, AW, Kramer, DJ, Kusne, S, Manez, R. The duration of fecal carriage of vancomycin-resistant Enterococcus faecium (VREF). Presented at the 34th Interscience Conference of Antimicrobial Agents and Chemotherapy; 1994; Orlando FL. Abstract J150.Google Scholar
26.Gordts, B, Claeys, K, Jannes, H, Van Landuyt, HW. Are vancomycin-resistant enterococci normal inhabitants of the gastrointestinal tract of hospitalized patients? Presented at the 34th Interscience Conference of Antimicrobial Agents and Chemotherapy; 1994; Orlando FL. Abstract J151.Google Scholar
27.Wade, JJ, Desai, N, Casewell, MW. Hygienic hand disinfection for the removal of epidemic vancomycin-resistant Enterococcus faecium and gentamicin-resistant Enterobacter cloacae. J Hosp Infect 1991;18: 211–218.Google Scholar
28.Norris, AH, Reilly, JP, Edelstein, PH, Brennan, PJ, Schuster, MG. Chloramphenicol for the treatment of vancomycin-resistant enterococcal infections. Clin Infect Dis 1995;20:1137–1144.Google Scholar
29.Montecalvo, MA, Horowitz, H, Carbonaro, CA, Seiter, K, Wormser, GP. Effect of novobiocin-containing antimicrobial regimens on infection and colonization with vancomycin-resistant Enterococcus faecium. Antimicrob Agents Chemother 1995;39:794.Google Scholar
30.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:1123–1128.Google Scholar
31.Wells, CL, Juni, BA, Cameron, SB, et al.Stool carriage, clinical isolation, and mortality during an outbreak of vancomycin-resistant enterococci in hospitalized medical and/or surgical patients. Clin Infect Dis 1995;21:45–50.Google Scholar