Control of endemic glycopeptide-resistant enterococci.
OBJECTIVE
To evaluate the epidemiology of, and control measures for, vancomycin-resistant Enterococcus (VRE) in a renal unit.


METHODS
A 3-month, prospective, prevalence culture survey of patients on a 24-bed renal unit.


METHODS
A 975-bed community teaching hospital.


METHODS
Patients admitted to the renal unit over a 3-month period. Patients identified with VRE were each matched with four patients without VRE isolated over the study period. INTERVENTIONS/CONTROL MEASURES: Resistant-organism barrier precautions. To eradicate carriage of VRE, two patients with VRE stool colonization were treated with 5 days of oral doxycycline (100 mg twice per day) and rifampin (300 mg/day).


RESULTS
Seven patients with VRE (8 isolates) were identified. Five isolates were Enterococcus faecium (vancomycin MIC = 16 to 256 micrograms/mL), two were Enterococcus faecalis (MICs = 16 and 124 micrograms/mL), and one was Enterococcus gallinarum (MIC = 8.0 micrograms/mL). Eradication of carriage with VRE was accomplished in two patients treated with doxycycline and rifampin. In the final 30 days of the culture survey and at 9 months, there were no further patients with VRE identified.


CONCLUSIONS
Resistant-organism precautions and elimination of patient carriage may be useful measures for controlling the spread of low-prevalence endemic vancomycin-resistant Enterococcus.
Dembry
L M
LM
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
Uzokwe
K
K
Zervos
M J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D016022:Case-Control Studies; D003428:Cross Infection / Q000517:prevention & control*; D004352:Drug Resistance, Microbial; D013293:Enterococcus faecalis; D016984:Enterococcus faecium; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D014640:Vancomycin
D000900:Anti-Bacterial Agents; D014640:Vancomycin