Prevalence of vancomycin-resistant enterococci in fecal samples from hospitalized patients and nonhospitalized controls in a cattle-rearing area of France

Vancomycin-resistant enterococci (VRE) have emerged as nosocomial pathogens over the last decade, but little is known about their epidemiology. We rep ort on the prevalence of VRE fecal colonization on the basis of a prospecti ve study among patients hospitalized in a hematology intensive care unit an d among nonhospitalized subjects living in the local community, A total of 243 rectal swabs from hematology patients and 169 stool samples from the co ntrol group were inoculated onto bile-esculin agar plates with and without 6 mg of vancomycin per liter and into an enrichment bile-esculin broth supp lemented with 4 mg of vancomycin per liter, A total of 37% of the hospitali zed patients and 11.8% of the subjects from the community were found to be VRE carriers. A total of 65 VRE strains were isolated: 12 (18.5%) E. faeciu m, 46 (70.7%) E. gallinarum, and 7 (10.8%) E. casseliflavus strains. No E. faecalis strains were detected. All the E, faecium strains were of the vanA genotype. Molecular typing by pulsed-field gel electrophoresis revealed a different pattern for each vanA VRE strain that originated from an individu al subject. To our knowledge, this is the first study to be carried out in a cattle-rearing region of France. It reports a higher VRE prevalence than that reported in previous European or U.S. studies. A partial explanation i s the use of an enrichment broth step which enabled detection of strains wh ich would otherwise have been missed, but the fact that subjects and patien ts were recruited from a predominantly agricultural area where vancomycin-r elated antibiotics have recently been used in animal husbandry could also c ontribute to the high levels of VRE in patients and subjects alike.