STOOL CARRIAGE, CLINICAL ISOLATION, AND MORTALITY DURING AN OUTBREAK OF VANCOMYCIN-RESISTANT ENTEROCOCCI IN HOSPITALIZED MEDICAL AND OR SURGICAL PATIENTS/

During a nosocomial outbreak of infection due to vancomycin-resistant enterococci (VRE), rectal swabs that were collected weekly were used t o identify and isolate VRE carriers. Over 6 months, 1,458 stool specim ens from 724 high-risk patients were cultured, and 187 VRE isolates we re recovered from 61 patients; 96% of the isolates were Enterococcus f aecium. VRE tended to be isolated from clinical specimens from patient s identified as VRE carriers by stool surveillance (P < .01). However, isolation of VRE from surveillance cultures preceded clinical isolati on for only similar to 50% of the patients from whom a clinical VRE is olate was recovered. Mortality was greater (P < .05) among patients fr om whom a clinical VRE isolate was recovered than among patients from whom VRE was isolated only by stool surveillance. The mortality (1 [17 %] of 6) among patients for whom VRE was isolated from blood was simil ar to that (10 [27%] of 37) among patients for whom vancomycin-suscept ible enterococcus was isolated from blood (P = .97). Despite prompt in itiation of contact precautions for VRE carriers, the incidence of fec al carriage of VRE remained similar to 8% among this patient populatio n for the 6-month period of the study.