Low prevalence of VRE gastrointestinal colonization
Low prevalence of VRE gastrointestinal colonization of hospitalized patients in Manitoba tertiary care and community hospitals
Vancomycin-resistant Enterococcus faecium (VREF) accounts for up to 65% of Efaecium isolates in hospitalized patients across the United States and is endemic in many North American tertiary care institutions. The management of these infections presents a significant clinical challenge because species of the genus Enterococcus, and in particular Efaecium, are frequently resistant to several antimicrobial agents. High level penicillin resistance, high level aminoglycoside resistance and most recently vancomy- cin resistance are emerging as significant concerns in the treatment of enterococcal infections. This has prompted the development and evaluation of new antimicrobial agents such as quinupristin/dalfopristin and LY333328, a glycopeptide, which may offer activity against enterococci resistant to conventional therapy.
VREF is not endemic in Manitoba hospitals, and infection with VREF is extremely rare. However, the prevalence of VREF lower gastrointestinal tract (GIT) carriage, which frequently precedes infection, is presently unknown for patients hospitalized in Manitoba. To determine whether the lack of VREF endemnicity correlated with an absence of lower GIT colonization, we assessed lower GIT carriage of VREF for patients hospitalized in 10 Manitoba hospitals from January 1 to December 31, 1997. Our study was consistent with Centers for Disease Control and Prevention guidelines (Atlanta, Georgia) that suggest surveillance programs for vancomycin- resistant enterococci (VRE) be undertaken on an intermittent basis in areas where VRE is not known to be endemic. Isolates of VREF identified were phenotypically and genotypically characterized, and tested for their susceptibilities against a panel of antimicrobial agents.
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