VANCOMYCIN-RESISTANT ENTEROCOCCI OUTSIDE THE HEALTH-CARE SETTING - PREVALENCE, SOURCES, AND PUBLIC-HEALTH IMPLICATIONS

Although nosocomial acquisition and subsequent colonization of vancomy cin-resistant enterococci (VRE), an emerging international threat to p ublic health, has been emphasized in the United States, colonization a mong nonhospitalized persons has been infrequently documented. In cont rast, in Europe, colonization appears to occur frequently in persons o utside the health-care setting. An important factor associated with VR E in the community in Europe has been avoparcin, a glycopeptide antimi crobial drug used for years in many European nations at subtherapeutic doses as a growth promoter in food-producing animals. In Europe, evid ence suggests that foodborne VRE may cause human colonization. Althoug h avoparcin has never been approved for use in the United States, unde tected community VRE transmission may be occurring at low levels. Furt her studies of community transmission of VRE in the United States are urgently needed. If transmission with VRE from unrecognized community sources can be identified and controlled, increased incidence of colon ization and infection among hospitalized patients may be prevented.