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Stool Colonization With Vancomycin-Resistant Enterococci in Healthcare Workers and Their Households

Published online by Cambridge University Press:  02 January 2015

Joseph Baran Jr. ,
Jambunathan Ramanathan ,
Kathleen M. Riederer  and
Riad Khatib
Joseph Baran Jr.*
Affiliation:
St. John Hospital, & Medical Center, Detroit, Michigan
Jambunathan Ramanathan
Affiliation:
St. John Hospital, & Medical Center, Detroit, Michigan
Kathleen M. Riederer
Affiliation:
St. John Hospital, & Medical Center, Detroit, Michigan
Riad Khatib
Affiliation:
St. John Hospital, & Medical Center, Detroit, Michigan
*
Medical Education Department, St. John Hospital & Medical Center, 22101 Moross Road, Detroit, MI 48236
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Abstract

Objective:

To determine the prevalence of stool colonization with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) and their families.

Design:

Prospective assessment of fecal colonization with VRE.

Setting:

A 603-bed, tertiary-care teaching hospital.

Participants:

Healthy volunteers recruited from hospital employees and their households were screened to exclude pregnancy, diabetes mellitus, immunosuppressive disorders, and recent use of antimicrobials.

Intervention:

Self-obtained stool swabs were used to obtain cultures. Isolated enterococci were screened for vancomycin resistance and species were identified. Intra-household isolates were genotyped using pulsed-field gel electrophoresis (PFGE).

Results:

The participants (n = 228; age range, 28 days to 80 years) were from 137 households with and 91 without employees who had contact with patients. Enterococcus species were isolated from 127 stool specimens (55.7%). VRE were detected in 12 individuals, representing 6 E. casseliflavus, 5 E. faecium, and 1 E. gallinarum. VRE were more commonly isolated in employees who had contact with patients (5 of 52 vs 0 of 40; relative risk [RR], 1.9; 95% confidence interval [CI95], 1.5 to 2.2; P = .07) and their household members (10 of 137 vs 2 of 91; RR, 3.3; CI95, 0.7 to 14.8; P = .13). In 2 households (2 adults in a physician's household and an adult plus a child in a nurse's household) PFGE analysis demonstrated identical intra-household strains of vancomycin-resistant E. faecium.

Conclusions:

VRE colonization was found in 5.3% of screened stools and was more prevalent in HCWs who had contact with patients and their households. Identical PFGE patterns between 2 employees who had contact with patients and their household members demonstrated probable intra-household spread. Although the mode of acquisition was uncertain, the association with employees who had contact with patients suggests possible occupational sources. These findings demonstrate the spread of VRE within the household and implicate occupational risk for its acquisition.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 1 , January 2002 , pp. 23 - 26
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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