Outcome of a screening program for vancomycin-resistant enterococci in a hospital in Victoria

Objective: To screen for faecal colonisation with vancomycin-resistant ente rococci (VRE) among potentially at-risk patients. Design: Infection control screening program. Setting: Monash Medical Centre (a tertiary care hospital), Melbourne, Victo ria, in the seven months from June 1997. Patients: Patients in the Renal, Oncology and Intensive Care (ICU) Units. Main outcome measures: Presence of VRE in a rectal swab or faecal specimen taken at admission and at regular intervals during inpatient stay; presence of vancomycin-resistance genes (vanA, vanB and vanC) assessed by polymeras e chain reaction (PCR); genetic clonality of isolates assessed by pulsed-fi eld gel electrophoresis (PFGE). Results: 574 patients (356 renal, 134 ICU and 84 oncology) were screened; 1 2 were colonised with VRE - nine renal inpatients, two having peritoneal di alysis or in-centre haemodialysis, and one ICU patient. Nine isolates were Enterococcus faecalis (seven positive for vanB and two negative for all thr ee resistance genes) and three were Enterococcus faecium (all positive for vanB). Eight were high-level gentamicin resistant. PFGE suggested genetic c lonality between the index isolate and five other isolates from renal patie nts. No specific clinical practice was associated with VRE colonisation. At tempts to clear rectal carriage with oral ampicillin/amoxycillin or bacitra cin were of limited success. Although antibiotic prescribing in the Renal U nit was generally consistent with defined protocols, use of vancomycin and third-generation cephalosporins has been further restricted. Conclusions: Renal inpatients in our institution appear most at risk of VRE colonisation (4.6% overall) and therefore of VRE infection. Routine screen ing, especially of potentially high-risk patients, should be considered in major Australian hospitals.