title: Infection and colonization with vancomycin-resistant Enterococcus faecium in an acute care Veterans Affairs Medical Center: a 2-year survey.
abstract: BACKGROUND
  After our first known patient with vancomycin-resistant enterococci (VRE) infection was admitted in 1993, we observed a gradual increase in infections and colonization caused by this organism. Thus we initiated a prospective study to quantitate the incidence of VRE infection versus colonization, to identify risk factors for VRE, and to define the natural history of VRE colonization among our patients.
  
  
  METHODS
  Stool/rectal cultures were performed for patients admitted to the intensive care units at the time of admission and weekly thereafter. Patients found to be carrying VRE were followed with cultures every 2 weeks, and this protocol was continued after transfer to the medical-surgical wards. A surveillance form was initiated on each VRE patient and included demographics, underlying diseases, and risk factors. Environmental cultures in the intensive care units were randomly performed. Patients with positive cultures were isolated.
  
  
  RESULTS
  During a 27-month period, 210 patients were found to be colonized or infected with VRE. Ages ranged from 35 to 97 years; the mean age was 65 years. Fourteen percent (29 of 210) of the patients were VRE positive on admission. Nosocomial colonization or infection occurred at an average of 28 days after admission. Seventeen percent (25 of 216) of patients cleared VRE during their hospital stay; 19% (40 of 210) developed 47 infections. One third of infections involved the urinary tract. Liver transplantation, chemotherapy, and total parenteral nutrition were each associated with infection.
  
  
  CONCLUSIONS
  Routine measures as advocated by the Centers for Disease Control and Prevention were not effective in controlling VRE in our patient population.
authors.affiliation: Veterans Affairs Medical Center, Pittsburgh, PA, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Goetz
authors.forename: J D
authors.initials: JD
authors.lastname: Rihs
authors.forename: M M
authors.initials: MM
authors.lastname: Wagener
authors.forename: R R
authors.initials: RR
authors.lastname: Muder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D002353:Carrier State / Q000382:microbiology* / Q000517:prevention & control; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D004352:Drug Resistance, Microbial; D016984:Enterococcus faecium; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000517:prevention & control; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D011446:Prospective Studies; D012307:Risk Factors; D014640:Vancomycin
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin