Hostname: page-component-745bb68f8f-l4dxg Total loading time: 0 Render date: 2025-01-14T20:14:52.480Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence and Determinants of Fecal Colonization with Vancomycin-Resistant Enterococcus in Hospitalized Patients in The Netherlands

Published online by Cambridge University Press:  02 January 2015

Nicole van den Braak ,
Alewijn Ott ,
Alex van Belkum ,
Jan A.J.W. Kluytmans ,
Johannes G.M. Koeleman ,
Lodewijk Spanjaard ,
Andreas Voss ,
Annemarie J.L. Weersink ,
Christina M.J.E. Vandenbroucke-Grauls  and
Anton G.M. Buiting
...Show all authors
Nicole van den Braak*
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus University Rotterdam, The Netherlands
Alewijn Ott
Affiliation:
Department of Epidemiology and Biostatistics, Erasmus University Rotterdam, The Netherlands
Alex van Belkum
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus University Rotterdam, The Netherlands
Jan A.J.W. Kluytmans
Affiliation:
Working Party Hospital Infection Epidemiology Netherlands, Breda, The Netherlands Ignatius Hospital, Breda, The Netherlands
Johannes G.M. Koeleman
Affiliation:
Working Party Hospital Infection Epidemiology Netherlands, Breda, The Netherlands University Hospital Vrije Universiteit, Amsterdam, The Netherlands
Lodewijk Spanjaard
Affiliation:
Working Party Hospital Infection Epidemiology Netherlands, Breda, The Netherlands Academic Medical Center, Amsterdam, The Netherlands
Andreas Voss
Affiliation:
Working Party Hospital Infection Epidemiology Netherlands, Breda, The Netherlands University Hospital, Nijmegen, The Netherlands
Annemarie J.L. Weersink
Affiliation:
Working Party Hospital Infection Epidemiology Netherlands, Breda, The Netherlands University Hospital, Utrecht, The Netherlands
Christina M.J.E. Vandenbroucke-Grauls
Affiliation:
Working Party Hospital Infection Epidemiology Netherlands, Breda, The Netherlands University Hospital Vrije Universiteit, Amsterdam, The Netherlands
Anton G.M. Buiting
Affiliation:
Elisabeth Hospital, Tilburg, The Netherlands
Henri A. Verbrugh
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus University Rotterdam, The Netherlands Working Party Hospital Infection Epidemiology Netherlands, Breda, The Netherlands
Hubert P. Endtz
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus University Rotterdam, The Netherlands
*
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the prevalence and determinants of fecal carriage of vancomycin-resistant enterococci (VRE) in intensive care unit (ICU), hematology-oncology, and hemodialysis patients in The Netherlands.

Design:

Descriptive, multicenter study, with yearly 1-week point-prevalence assessments between 1995 and 1998.

Population:

All patients hospitalized on the testing days in ICUs and hematology-oncology wards in nine hospitals in The Netherlands were included.

Methods:

Rectal swabs obtained from 1,112 patients were screened for enterococci in a selective broth and subcultured on selective media with and without 6 mg/L vancomycin. Resistance genotypes were determined by polymerase chain reaction. Further characterization of VRE strains was done by pulsed-field gel electrophoresis (PFGE). We studied possible determinants of VRE colonization with a logistic regression analysis model. Determinants analyzed included gender, age, and log-transformed length of prior hospital stay.

Results:

The results showed that 614 (55%) of 1,112 patients were colonized with vancomycin-sensitive enterococci, and 15 (1.4%) of 1,112 carried VRE. No increase in VRE colonization was observed from 1995 to 1998. Eleven strains were identified as Enterococcus faecium and four as Enterococcus faecalis. All E faecium and one E faecalis carried the vanA gene; the other E faecalis strains harbored the vanB gene. PFGE revealed that three vanB VRE isolated from patients hospitalized in one single ICU were related, suggesting nosocomial transmission. Though higher age seemed associated with VRE colonization, exclusion of patients with the nosocomial strain from the regression analysis decreased this relation to nonsignificant. Duration of hospital stay was not associated with VRE colonization.

Conclusion:

VRE colonization in Dutch hospitals is an infrequent phenomenon. Although nosocomial spread occurs, most observed cases were unrelated, which suggests the possibility of VRE acquisition from outside the hospital. Prolonged hospital stay, age, and gender proved unrelated to VRE colonization.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 8 , August 2000 , pp. 520 - 524
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Martone, WJ. Spread of vancomycin-resistant enterococci: why did it happen in the Unites States? Infect Control Hosp Epidemiol 1998;19:539–545.Google Scholar
2.Reinert, RR, Conrads, G, Schlaeger, JJ, Werner, G, Witte, W, Lutticken, R, et al. Survey of antibiotic resistance among enterococci to North Rhine-Westphalia, Germany. J Clin Microbiol 1999;37:1638–1641.Google Scholar
3.Simonsen, GS, Andersen, BM, Digranes, A, Harthug, S, Jacobsen, T, Lingaas, E, et al. Low fecal carrier rate of vancomycin resistant enterococci in Norwegian hospital patients. Scand J Infect Dis 1998;30:465–468.Google Scholar
4.Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin in the United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
5.Chow, JW, Kuritza, A, Schlaes, DA, Green, M, Sahm, DF, Zervos, MJ. Clonal spread of vancomycin-resistant Enterococcus faecium between patients in three hospitals in two states. J Clin Microbiol 1993;31:1609–1611.Google Scholar
6.Pegues, DA, Pegues, CF, Hibberd, PL, Ford, DS, Hooper, CP. Emergence and dissemination of a highly vancomycin-resistant vanA strain of Enterococcus faecium at a large teaching hospital. J Clin Microbiol 1997;35:1565–1570.Google Scholar
7.Gordts, B, Van Landuyt, H, Ieven, M, Vandamme, P, Goossens, H. Vancomycin-resistant enterococci colonizing the intestinal tracts of hospitalized patients. J Clin Microbiol 1995;33:2842–2846.Google Scholar
8.Boisivon, A, Thibault, M, Leclerq, R, the Collège de Bactériologie-Virologie-Hygiène des Hôpitaux Généraux Français. Cololnization by vancomycin resistant enterococci of the intestinal tract of patients in intensive care units from French general hospitals. Clinical Microbiology and Infection 1997;3:175–179.Google Scholar
9.Bates, J, Jordens, JZ, Griffiths, DT. Farm animals as a putative reservoir for vancomycin-resistant enterococcal infection in man. J Antimicrob Chemother 1994;34:507–516.Google Scholar
10.Endtz, HP, van den Braak, N, van Belkum, A, Kluytmans, JA, Koeleman, JG, Spanjaard, L, et al. Fecal carriage of vancomycin-resistant enterococci in hospitalized patients and those living in the community in The Netherlands. J Clin Microbiol 1997;35:3026–3031.Google Scholar
11.van Belkum, A, van den Braak, N, Thomassen, R, Verbrugh, H, Endtz, H. Vancomycin-resistant enterococci in cats and dogs. Lancet 1996;348:1038–1039.Google Scholar
12.Goossens, H. Spread of vancomycin-resistant enterococci: differences between the United States and Europe. Infect Control Hosp Epidemiol 1998;19:546–551.Google Scholar
13.Kanamycin aesculin azide (KAA) agar. Int J Food Microbiol 1987;5:731–734.Google Scholar
14.Boom, R, Sol, CJA, Salimans, MMM, Jansen, CL, Wertheim-van Dillen, PME, Van der Noordaa, J. Rapid and simple method for purification of nucleic acids. J Clin Microbiol 1990;28:495–503.Google Scholar
15.Dutka-Malen, S, Evers, S, Courvalin, P. Detection of glycopeptide resistance genotypes and identification of the species level of clinically relevant enterococci by PCR. J Clin Microbiol 1995;33:24–27.Google Scholar
16.van den Braak, N, van Belkum, A, van Keulen, M, Vliegenthart, J, Verbrugh, HA, Endtz, HPH. Molecular characterization of vancomycin-resistant enterococci from hospitalized patients and poultry products in The Netherlands. J Clin Microbiol 1998;36:1927–1932.Google Scholar
17.Tenover, FC, Arbeit, RD, Goering, RV, Mickelsen, PA, Murray, BE, Persing, DH, 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
18.Trabulsi, A, Glover, AM, Reising, SF, Christie, CD. Absence of rectal colonization with vancomycin-resistant enterococci among high-risk pediatric patients. Infect Control Hosp Epidemiol 1998;2:109–112.Google Scholar
19.Noble, CJ. Carriage of group D streptococci in the human bowel. J Clin Pathol 1978;31:1182–1186.Google Scholar
20.Swalbe, RS, McIntosh, AC, Qaiyumi, A, Johnson, JA, Johnson, RJ, Furness, KM, et al. In vitro activity of LY333328, an investigational glycopeptide antibiotic, against enterococci and staphylococci. Antimicrob Agents Chemother 1996;40:2416–2419.Google Scholar
21.A ban of the use of some antibiotics in animal feed [press release]. Brussels, Belgium: European Commission; December 10,1998.Google Scholar
22.Klare, I, Badstubner, D, Konatbel, C, Bohme, G, Claus, H, Witte, W. Decreased incidence of vanA type vancomycin-resistant enterococci isolated from poultry meat and from fecal samples of humans in the community after discontinuation of avoparcin usage in animal husbandry. Microb Drug Resist 1999;5:45–52.CrossRefGoogle ScholarPubMed
23.Willems, RJL, Top, J, van den Braak, N, van Belkum, A, Mevius, DJ, Hendriks, G, et al. Molecular diversity and evolutionary relationships of Tn 1546-like elements in enterococci from humans and animals. Antimicrob Agents Chemother 1999;43:483–491.Google Scholar
24.Rao, GG, Ojo, F, Kolokithas, D. Vancomycin-resistant gram-positive cocci: risk factors for faecal carriage. J Hosp Infect 1997;35:63–69.Google Scholar
25.Spera, RV Jr, Farber, BF. Multidrug-resistant Enterococcus faecium. An untreatable nosocomial pathogen. Drugs 1994;48:678–688.CrossRefGoogle ScholarPubMed
26.Roghmann, MC, Fink, JC, Polish, L, Maker, T, Brewrink, J, Morris, JG Jr, et al. Colonization with vancomycin-resistant enterococci in chronic hemodialysis patients. Am J Kidney Dis 1998;32:254–257.Google Scholar
27.Bhorade, SM, Christenson, J, Pohlman, AS, Arnow, PM, Hall, JB. The incidence of and clinical variables associated with vancomycin-resistant enterococcal colonization in mechanically ventilated patients. Chest 1999;115:1085–1099.Google Scholar
28.Gin, AS, Zhanel, GG. Vancomycin-resistant enterococci. Ann Pharmacother 1996;30:615–624.Google Scholar