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Spread of Vancomycin-Resistant Enterococci: Why Did It Happen in the United States?

Published online by Cambridge University Press:  02 January 2015

William J. Martone
William J. Martone*
Affiliation:
National Foundation for Infectious Diseases, Bethesda, Maryland
*
National Foundation for Infectious Diseases, 4733 Bethesda Ave, Suite 750, Bethesda, MD, 20814; e-mail, wjmartone@aol.com.
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Abstract

The question of why vancomycin-resistant enterococci (VRE) became epidemic in the United States can be answered on at least three basic levels: (1) molecular and genetic, (2) factors affecting host-microbe interactions, and (3) epidemiological. This article will address the epidemiological issues and seek to defend the assertion that, once VRE had evolved, its spread throughout hospitals in the United States was all but assured. Nosocomial VRE outbreaks were reported first in the mid- and late-1980s. Since that time, scientific reports of VRE have increased over 20-fold. Among hospitals participating in the National Nosocomial Infection Surveillance System from 1989 to 1997, the percentage of enterococci reported as resistant to vancomycin increased from 0.4% to 23.2% in intensive-care settings and from 0.3% to 15.4% in non-intensive-care settings. Factors leading to the spread of VRE in US hospitals include (1) antimicrobial pressure, (2) sub-optimal clinical laboratory recognition and reporting, (3) unrecognized “silent” carriage and prolonged fecal carriage, (4) environmental contamination and survival, (5) intrahospital and interhospital transfer of colonized patients, (6) introduction of unrecognized carriers from community settings such as nursing homes, and (7) inadequate compliance with hand washing and barrier precautions. Guidelines developed by the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee address each of these factors. The impact of these guidelines on the spread of VRE within individual institutions has been variable, and the overall impact of the guidelines nationally is unknown.

Type
From the Fifth International Conference on the Prevention of Infection
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 8 , August 1998 , pp. 539 - 545
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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