Major article
Vancomycin-resistant Enterococcus colonization before admission to the intensive care unit: A clinico-epidemiologic analysis

https://doi.org/10.1016/j.ajic.2008.09.025Get rights and content

Background

Asymptomatic vancomycin-resistant Enterococcus (VRE) colonization is known to precede actual infection. Since VRE was first isolated in Korea in 1992, the VRE isolation rate has rapidly increased in tertiary hospitals.

Methods

We performed a prospective observational study to estimate the prevalence of VRE colonization among inpatients at the time of intensive care unit (ICU) admission. From March through December 2007, rectal swab cultures were taken in all patients admitted to the ICU. We aimed to identify the risk factors for VRE colonization on admission.

Results

During the study period, 34 (4.4%) out of 780 patients were already colonized with VRE before ICU admission: 21 out of 323 patients from general wards (6.5%) and 13 out of 437 patients from outside the hospital (2.97%). VRE-colonized patients were more likely than uncolonized patients to have infectious diseases and to have been referred from outside hospitals (P < .01). Previous hospitalization (P = .01) and antibiotic exposure (P < .01) were risk factors for VRE colonization before ICU admission. Pulsed-field gel electrophoresis patterns were diverse. Initial VRE colonization correlated to poor prognosis.

Conclusion

VRE colonization rate was not negligible among newly admitted ICU patients, suggesting that an active surveillance program focusing on high-risk groups may be helpful.

Section snippets

Patients and study design

The Korea University Guro Hospital, located in southwestern Seoul, is a 650-bed tertiary care hospital with a 35-bed medical and surgical ICU. We performed a prospective observational study to estimate the prevalence of VRE colonization among inpatients at the time they were admitted to this ICU. From March to December 2007, we obtained rectal swab cultures within 48 hours of ICU admission to detect VRE colonization that had occurred prior to the ICU entrance of each patient. Patients who

Results

Of the 1276 patients admitted to the ICU during the 10-month study period, 780 remained there for more than 48 hours and were therefore eligible for this study. We found that 34 out of 780 patients (4.4%) were already colonized with VRE upon ICU admission: 6.5% (21 out of 323 patients) were transferred from general wards, and 2.97% (13 out of 437 patients) were from outside of the hospital (Fig 1). We isolated 33 E faecium and 1 E faecalis strains, all of which carried the vanA gene. In

Discussion

This study was designed to evaluate prior VRE colonization rates and their clinical significance among acutely ill patients entering the ICU of a large tertiary hospital. The overall colonization rate was 4.4%, lower than rates previously reported by Ostrowsky et al11 and Bonten et al12 in the mid-1990s. Ostrowsky et al11 reported that VRE colonization had already occurred in 12% of patients (35 out of 290) at the time of surgical ICU admission. This high prevalence of colonization compared

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Conflict of interest: All authors report no conflicts of interest.

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