COLONIZATION WITH VANCOMYCIN-RESISTANT ENTEROCOCCI IN CHRONIC-HEMODIALYSIS PATIENTS

Vancomycin-resistant enterococcus (VRE) has been identified with incre ased frequency in dialysis populations, but the risk factors for VRE c olonization are not well defined in hemodialysis patients. Patients fr om a university-affiliated outpatient dialysis center had surveillance stool or rectal cultures for VRE during April 1994 and January 1996. The combined cohort of 168 patients was followed-up for all-cause mort ality, subsequent hospitalization, and VRE infection. Demographic and risk factor information, including age, gender, race, diabetes, corona ry artery disease (CAD), and human immunodeficiency virus (HIV) infect ion, were collected on all patients. Sixteen patients had surveillance cultures grow vancomycin-resistant Enterococcus faecium or E faecalis (VREF), and nine additional patients had clinical cultures positive f or VREF. The median follow-up time for patients with positive surveill ance or clinical cultures for VREF was 421 days versus 423 days for th ose without VREF Patients with positive surveillance cultures for VREF had less time on hemodialysis before screening (median = 207 days v 8 22 days; P < 0.01), and more hospitalization in the year before screen ing (median = 19 days v 3 days, P < 0.01) compared with those without VREF. Patients with VREF colonization were more likely to develop infe ction with VREF (25% v l%, P < 0.01) than those without VREF colonizat ion. However, adjusting for age, diabetes, coronary artery disease, an d acquired immune deficiency syndrome (AIDS) using Cox-proportional ha zards models, the presence of VREF on screening culture was not associ ated with increased risk of death (RR = 1.1, P = 0.86). Thus after adj usting for other comorbidities, VREF colonization was not associated w ith increased mortality. Patients with end-stage renal disease (ESRD) on hemodialysis who are hospitalized are more likely to have VREF, but longer duration on hemodialysis was not associated with presence of t his organism. This suggests that VRE transmission occurs predominantly in the inpatient setting. (C) 1998 by the National Kidney Foundation, Inc.