Infection and colonization with vancomycin-resistant Enterococcus faecium in an acute care Veterans Affairs Medical Center: A 2-year survey

Background: After our first known patient with vancomycin-resistant enteroc occi (VRE) infection was admitted in 1993, we observed a gradual increase i n infections and colonization caused by this organism. Thus we initiated a prospective study to quantitate the incidence of VRE infection versus colon ization, to identify risk factors for VRE, and to define the natural histor y of VRE colonization among our patients. Methods: Stool/rectal cultures were performed fur patients admitted to the intensive care units at the time of admission and weekly thereafter. Patien ts found to be carrying VRE were followed with cultures every 2 weeks, and this protocol was continued after transfer to the medical-surgical wards. A surveillance form was initiated on each VRE patient and included demograph ics, underlying diseases, and risk factors, Environmental cultures in the i ntensive care units were randomly performed. Patients with positive culture s were isolated. Results: During a 27-month period, 210 patients were found to be colonized or infected with VRE. Ages ranged from 35 to 97 years; the mean age was 65 years. Fourteen percent (29 of 210) of the patients were VRE positive on ad mission. Nosocomial colonization or infection occurred at an average of 28 days after admission. Seventeen percent (25 of 216) of patients cleared VRE during their hospital stay: 19% (30 of 210) developed 47 infections. One t hird of infections involved the urinary tract. Liver transplantation, chemo therapy, and total parenteral nutrition were each associated with infection . Conclusion: Routine measures as advocated by the Centers for Disease Contro l and prevention were not effective in controlling VRE in our patient popul ation.