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Natural History of Colonization with Vancomycin-Resistant Enterococcus Faecium

Published online by Cambridge University Press:  02 January 2015

Marisa A. Montecalvo ,
Herminia de Lencastre ,
Margaret Carraher ,
Cheryl Gedris ,
Marilyn Chung ,
Ken VanHorn  and
Gary P. Wormser
Marisa A. Montecalvo*
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York
Herminia de Lencastre
Affiliation:
Laboratory of Microbiology, The Rockefeller University, New York, New York
Margaret Carraher
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York
Cheryl Gedris
Affiliation:
Department of Pathology, New York Medical College, Valhalla, New York
Marilyn Chung
Affiliation:
Laboratory of Microbiology, The Rockefeller University, New York, New York
Ken VanHorn
Affiliation:
Department of Pathology, New York Medical College, Valhalla, New York
Gary P. Wormser
Affiliation:
Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York
*
Macy Pavilion 209 SE, Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595
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Abstract

Objective:

To determine the incidence, duration, and genetic diversity of colonization with vancomycin-resistant Enterococcus faecium (VREF).

Setting:

Oncology unit of a 650-bed university hospital.

Methods:

Surveillance perianal swab cultures were performed on admission and weekly. The molecular relatedness of VREF isolates was determined by pulsed-field gel electrophoresis and by the hybridization pattern of the vanA resistance determinant.

Results:

During 8 months of surveillance, the VREF colonization rate was 16.6 patients per 1,000 patient-hospital days, which was 10.6 times greater than the VREF infection rate. Eighty-six patients with VREF colonization were identified. Colonization persisted for at least 7 weeks in the majority of patients. Of 36 colonized patients discharged from the hospital and then readmitted, an average of 2½ weeks later, 22 (61%) patients still were colonized with VREF. Of the 14 patients who were VREF-negative at readmission, only three patients remained culture-negative throughout hospitalizations. PFGE demonstrated that colonization with the same VREF isolate may persist for at least 1 year, and patients may be colonized with more than one strain of VREF.

Conclusion:

VREF colonization is at least 10-fold more prevalent than infection among oncology patients. Colonization often persists throughout lengthy hospitalizations and may continue for long periods following hospitalization.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 12 , December 1995 , pp. 680 - 685
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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References

1. Schaberg, DR, Culver, DH, Gaynes, RP. Major trends in the microbial etiology of nosocomial infection. In: Martone, WJ, Garner, TS, eds. Proceedings of the Third Decennial International Conference on Nosocomial Infections. Am J Med 1991;91(3B):72–76.Google Scholar
2. Leclercq, R. Derlot, E, Duval, J, Courvalin, P. Plasmid mediated resistance to vancomycin and teicoplanin in Enterococcus faecium . N Engl J Med 1988;319:157–161.Google Scholar
3. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States 1989-1993. MMWR 1993;42:597–599.Google Scholar
4. Frieden, TR, Munsiff, SS, Low, DE, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76–79.CrossRefGoogle ScholarPubMed
5. Noble, WC, Virani, Z, Cree, RGA. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus . FEMS Microbiol Lett 1992;93:195–198.CrossRefGoogle Scholar
6. Karanfil, LV, Murphy, M, Josephson, A, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195–200.CrossRefGoogle Scholar
7. Rubin, LG, Tucci, V, Cercenado, E, Eliopoulos, G, Isenberg, HD. Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700–705.CrossRefGoogle ScholarPubMed
8. Livornese, LL Jr Dias, S, Samuel, C, et al. Hospital acquired infection with vancomycin resistant Enterococcus faecium transmitted by electric thermometers. Ann Intern Med 1992;117:112–116.Google Scholar
9. Handwerger, S, Raucher, B, Altarac, D, et al. Nosocomial out-break due to Enterococcus faecium resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.Google Scholar
10. Montecalvo, MA, Horowitz, H, Gedris, C, et al. Outbreak of vancomycin, ampicillin, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.Google Scholar
11. Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.CrossRefGoogle ScholarPubMed
12. Edmond, MD, Ober, JF, Weinbaum, DL, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1125–1133.CrossRefGoogle ScholarPubMed
13. Hariharan, R, Nathan, C, McMahon, C, Tyrrell, J, Kabins, S, Weinstein, RA. Epidemiology of vancomycin-resistant enterococci (VRE) in ICU patients. Presented at the 33rd Interscience Conference of Antimicrobial Agents and Chemotherapy; 1993; New Orleans, LA. Abstract 849.Google Scholar
14. Hospital Infection Control Practices Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105–113.CrossRefGoogle Scholar
15. Shay, DK, Maloney, SA, Montecalvo, MA, et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal blood-stream infections. J Infect Dis 1995;172:993–1000.Google Scholar
16. Falkham, RR, Washington, JA II. Streptococcus and related catalase-negative gram-positive cocci. In: Balows, A, Hausler, WJ Jr Herrmann, KL, Isenberg, HD, Shadomy, HJ, eds. Manual of Clinical Microbiology. 5th ed. Washington DC: American Society for Microbiology; 1991:238–257.Google Scholar
17. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. 5th ed. Villanova, PA: NCCLS; 1993. Approved standard. M2-A5.Google Scholar
18. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
19. De Lencastre, H, Couto, I, Santos, I, Melo-Cristino, J, Torres-Pereira, A, Tomasz, A. Methicillin-resistant Staphylococcus aureus disease in a Portuguese hospital: characterization of clonal types by a combination of DNA typing methods. Eur J Clin Microbiol Infect Dis 1994;13:64–73.CrossRefGoogle Scholar
20. Murray, BE, Singh, KV, Heath, JD, Sharma, BR, Weinstock, GM. Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites. J Clin Microbiol 1990;28:2059–2063.CrossRefGoogle ScholarPubMed
21. Goering, RV. Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 1993;14:595–600.Google Scholar
22. Handwerger, S, Skoble, J, Discotto, LF, Pucci, MJ. Heterogeneity of the vanA gene cluster in clinical isolates of enterococci from the Northeastern United States. Antimicrob Agents Chemother 1995;39:362–368.CrossRefGoogle ScholarPubMed
23. Rohlf, FJ, Sokal, RR. Statistical Tables. 3rd ed. New York, NY: WH Freeman and Company; 1995.Google Scholar
24. Vasquez, A, Lutfey, M, Tucci, L, Serrell, F, Kreiswirth, B, Simberkoff, M. Clinical, microbiologic and epidemiologic evaluation of vancomycin-resistant Enterococcus faecium (VREF). Presented at the 33rd Interscience Conference of Antimicrobial Agents and Chemotherapy; 1993; New Orleans, LA. Abstract 852.Google Scholar
25. Linden, P, Pasculle, AW, Kramer, DJ, Kusne, S, Manez, R. The duration of fecal carriage of vancomycin-resistant Enterococcus faecium (VREF). Presented at the 34th Interscience Conference of Antimicrobial Agents and Chemotherapy; 1994; Orlando FL. Abstract J150.Google Scholar
26. Gordts, B, Claeys, K, Jannes, H, Van Landuyt, HW. Are vancomycin-resistant enterococci normal inhabitants of the gastrointestinal tract of hospitalized patients? Presented at the 34th Interscience Conference of Antimicrobial Agents and Chemotherapy; 1994; Orlando FL. Abstract J151.Google Scholar
27. Wade, JJ, Desai, N, Casewell, MW. Hygienic hand disinfection for the removal of epidemic vancomycin-resistant Enterococcus faecium and gentamicin-resistant Enterobacter cloacae . J Hosp Infect 1991;18: 211–218.Google Scholar
28. Norris, AH, Reilly, JP, Edelstein, PH, Brennan, PJ, Schuster, MG. Chloramphenicol for the treatment of vancomycin-resistant enterococcal infections. Clin Infect Dis 1995;20:1137–1144.Google Scholar
29. Montecalvo, MA, Horowitz, H, Carbonaro, CA, Seiter, K, Wormser, GP. Effect of novobiocin-containing antimicrobial regimens on infection and colonization with vancomycin-resistant Enterococcus faecium . Antimicrob Agents Chemother 1995;39:794.CrossRefGoogle ScholarPubMed
30. Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1994;19:1123–1128.Google Scholar
31. Wells, CL, Juni, BA, Cameron, SB, et al. Stool carriage, clinical isolation, and mortality during an outbreak of vancomycin-resistant enterococci in hospitalized medical and/or surgical patients. Clin Infect Dis 1995;21:45–50.Google Scholar