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Duration of Colonization with Vancomycin-Resistant Enterococcus

Published online by Cambridge University Press:  02 January 2015

Karin E. Byers ,
Anne M. Anglim ,
Cynthia J. Anneski  and
Barry M. Farr
Karin E. Byers
Affiliation:
University of Virginia Health System, Charlottesville, Virginia
Anne M. Anglim
Affiliation:
University of Virginia Health System, Charlottesville, Virginia
Cynthia J. Anneski
Affiliation:
University of Virginia Health System, Charlottesville, Virginia
Barry M. Farr*
Affiliation:
University of Virginia Health System, Charlottesville, Virginia
*
PO Box 800473 UVA Health System, Charlottesville, VA 22908
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Abstract

Objective:

To determine the duration of colonization with vancomycin-resistant Enterococcus (VRE) and the adequacy of 3 consecutive negative cultures to determine clearance.

Design:

Retrospective cohort study.

Setting:

A university hospital.

Population:

Patients identified by perirectal cultures as VRE carriers who had follow-up cultures.

Methods:

Follow-up perirectal cultures were collected in inpatient and outpatient settings, at least 1 week apart, when patients were not receiving antibiotics with activity against VRE. The likelihood of culture positivity was analyzed given prior culture results and time from the initial positive culture.

Results:

A total of 116 patients colonized with VRE had 423 follow-up cultures, a mean of 204 days (range, 4 to 709 days) after their initial isolate. The first follow-up culture, collected a mean of 125 days after the initial positive isolate, was negative in 64%. After 1 negative follow-up culture, the next one was negative in 92% of the patients. After 2 negative cultures, 95% remained culture-negative. After 3 sequential negative cultures, 35 (95%) of 37 patients remained culture-negative. As the interval between the initial and the follow-up isolates increased, the probability that a subsequent culture would be positive decreased (P < .001, chi square for trend). Prolonged hospitalization, intensive care, and antibiotic use each decreased the likelihood of clearing VRE.

Conclusion:

These data support the Centers for Disease Control and Prevention criterion of 3 sequential negative cultures, at least 1 week apart, to remove patients from VRE isolation. Nevertheless, this may reflect a decrease in the quantity of VRE to an undetectable level and these patients should be observed for relapse, especially when re-treated with antibiotics.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 4 , April 2002 , pp. 207 - 211
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
2.Schaberg, DR, Culver, DH, Gaynes, RP. Major trends in the microbial etiology of nosocomial infection. Am J Med 1991;91:72S–75S.Google Scholar
3.Emori, TG, Gaynes, RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428–442.CrossRefGoogle ScholarPubMed
4.Boyce, JM, Opal, SM, Chow, JW. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
5.Handwerger, S, Raucher, B, Altarac, D, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.Google 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.Livornese, LL, Dias, S, Samel, C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.Google Scholar
8.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
9.Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44:1–13.Google Scholar
10.Montecalvo, MA, de Lencastre, H, Carraher, M, et al. Natural history of colonization with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1995;16:680–685.Google Scholar
11.Weinstein, MR, Dedier, H, Brunton, J, Campbell, I, Conly, JM. Lack of efficacy of oral bacitracin plus doxycycline for the eradication of stool colonization with vancomycin-resistant Enterococcus faecium. Clin Infect Dis 1999;29:361–366.Google Scholar
12.Green, M, Barbadora, K, Michaels, M. Recovery of vancomycin-resistant gram-positive cocci from pediatric liver transplant recipients. J Clin Microbiol 1991;29:2503–2506.Google Scholar
13.Lam, S, Singer, C, Tucci, V, Morthland, VH, Pfaller, MA, Isenberg, HD. The challenge of vancomycin-resistant enterococci: a clinical and epidemiologic study. Am J Infect Control 1995;23:170–180.CrossRefGoogle ScholarPubMed
14.Morris, JG, Shay, DK, Hebden, JN, et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin: establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250–259.Google Scholar
15.O'Donovan, CA, Fan-Havard, P, Tecson-Tumang, FT, Smith, SM, Eng, RH. Enteric eradication of vancomycin-resistant Enterococcus faecium with oral bacitracin. Diagn Microbiol Infect Dis 1994;18:105–109.CrossRefGoogle ScholarPubMed
16.Weinstein, JW, Tallapragada, S, Farrel, P, Dembry, LM. Comparison of rectal and perirectal swabs for detection of colonization with vancomycin-resistant enterococci. J Clin Microbiol 1996;34:210–212.CrossRefGoogle ScholarPubMed
17.National Committee on Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests, 5th ed. Wayne, PA: National Committee on Clinical Laboratory Standards; 1993.Google Scholar
18.Byers, KE, Anglim, AM, Anneski, CJ, et al. A hospital epidemic of vancomycin-resistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001;22:140–147.Google Scholar
19.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
20.Diem, K, Lentner, C, eds. Scientific Tables, 7th ed. Ardsley, NY: Geigy Pharmaceuticals; 1970.Google Scholar
21.Weinstein, MR, Brunton, J, Campbell, I, McGeer, A, Dedier, H, Conly, J. Oral bacitracin and doxycycline for the eradication of stool colonization by vancomycin-resistant Enterococcus faecium (VREF). Presented at the 36th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 1996; New Orleans, LA. Abstract J10.Google Scholar
22.Roghmann, M, Morris, JG. Longitudinal follow-up of cancer patient colonized by vancomycin-resistant enterococcus (VRE). Presented at the 34th Annual Meeting of the Infectious Diseases Society of America; September 1996; New Orleans, LA. Abstract 51.Google Scholar
23.Henning, KJ, Delencastre, H, Eagan, J, et al. Vancomycin-resistant Enterococcus faecium on a pediatric oncology ward: duration of stool shedding and incidence of clinical infection. Pediatr Infect Dis J 1996;15:848–854.CrossRefGoogle ScholarPubMed
24.Lai, KK, Fontecchio, S, Kelley, AL, Melvin, ZS. When is it safe to take patients colonized with vancomycin-resistant Enterococcus faecium (VREF) off isolation? Presented at the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 1995; San Francisco, CA. Abstract J36.Google Scholar
25.Linden, P, Pasculle, AW, Kramer, DJ. The duration of fecal carriage of vancomycin-resistant Enterococcus faecium (VREF). Presented at the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy; October 1994; Orlando, FL. Abstract J150.Google Scholar
26.Polish, L, Hebden, J, Shay, D. Duration of fecal carriage of vancomycin resistant Enterococcus (VRE) in ICU patients. Presented at the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 1995; San Francisco, CA. Abstract J37.Google Scholar
27.Lai, KK, Kelley, AL, Melvin, ZS, Belliveau, PP, Fontecchio, SA. Failure to eradicate vancomycin-resistant enterococci in a university hospital and the cost of barrier precautions. Infect Control Hosp Epidemiol 1998;19:647–652.Google Scholar
28.Baden, L, Thiemke, W, Skolnik, A, et al. Long-term colonization with vancomycin-resistant Enterococcus faecium. Presented at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 1998; San Diego, CA. Abstract K86.Google Scholar