Vancomycin-resistant enterococci among chronic hemodialysis patients: A prospective study of acquisition

To determine the prevalence and rate of acquisition of vancomycin-resistant enterococci (VRE) among patients undergoing chronic (i.e., long-term) hemo dialysis who were admitted to a tertiary care center, serial rectal culture s for VRE were performed at hospital admission and every 5 days until hospi tal discharge. A total of 7 (6%) of the 119 patients were colonized with VR E at admission. Six (19%) of the 32 patients who remained in the hospital g reater than or equal to4 days acquired VRE. A nonambulatory status was sign ificantly associated with colonization at admission (OR, 9.7; 95% CI, 1.8-5 3; P=.02), and vancomycin exposure was significantly associated with VRE ac quisition (relative risk, 1.8; 95% CI, 1.1-2.9; P=.02). All patients acquir ed VRE from epidemiologically linked dialysis patients colonized with simil ar VRE genotypes. Hospital acquisition of VRE contributes substantially to the increasing prevalence of VRE in the chronic hemodialysis patient popula tion.