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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
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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

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