title: Stool carriage, clinical isolation, and mortality during an outbreak of vancomycin-resistant enterococci in hospitalized medical and/or surgical patients.
abstract: During a nosocomial outbreak of infection due to vancomycin-resistant enterococci (VRE), rectal swabs that were collected weekly were used to identify and isolate VRE carriers. Over 6 months, 1,458 stool specimens from 724 high-risk patients were cultured, and 187 VRE isolates were recovered from 61 patients; 96% of the isolates were Enterococcus faecium. VRE tended to be isolated from clinical specimens from patients identified as VRE carriers by stool surveillance (P < .01). However, isolation of VRE from surveillance cultures preceded clinical isolation for only approximately 50% of the patients from whom a clinical VRE isolate was recovered. Mortality was greater (P < .05) among patients from whom a clinical VRE isolate was recovered than among patients from whom VRE was isolated only by stool surveillance. The mortality (1[17%] of 6) among patients for whom VRE was isolated from blood was similar to that (10 [27%] of 37) among patients for whom vancomycin-susceptible enterococcus was isolated from blood (P = .97). Despite prompt initiation of contact precautions for VRE carriers, the incidence of fecal carriage of VRE remained approximately 8% among this patient population for the 6-month period of the study.
authors.affiliation: Department of Laboratory Medicine, University of Minnesota Medical School, Minneapolis 55455-0374, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Wells
authors.forename: B A
authors.initials: BA
authors.lastname: Juni
authors.forename: S B
authors.initials: SB
authors.lastname: Cameron
authors.forename: K R
authors.initials: KR
authors.lastname: Mason
authors.forename: D L
authors.initials: DL
authors.lastname: Dunn
authors.forename: P
authors.initials: P
authors.lastname: Ferrieri
authors.forename: F S
authors.initials: FS
authors.lastname: Rhame
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D003422:Critical Care; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality*; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D016984:Enterococcus faecium / Q000187:drug effects / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin