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Natural History of Colonization with Vancoimycin-Resistant Enterococcus faecium

1995; Cambridge University Press; Volume: 16; Issue: 12 Linguagem: Inglês

10.1086/647041

1559-6834

Marisa A. Montecalvo, Hermı́nia de Lencastre, Margaret Carraher, Cheryl Gedris, Marilyn Chung, Ken VanHorn, Gary P. Wormser,

Infective Endocarditis Diagnosis and Management

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.