Outcome of a screening program for vancomycin-resistant enterococci in a hospital in Victoria.
OBJECTIVE
To screen for faecal colonisation with vancomycin-resistant enterococci (VRE) among potentially at-risk patients.


METHODS
Infection control screening program.


METHODS
Monash Medical Centre (a tertiary care hospital), Melbourne, Victoria, in the seven months from June 1997.


METHODS
Patients in the Renal, Oncology and Intensive Care (ICU) Units.


METHODS
Presence of VRE in a rectal swab or faecal specimen taken at admission and at regular intervals during inpatient stay; presence of vancomycin-resistance genes (vanA, vanB and vanC) assessed by polymerase chain reaction (PCR); genetic clonality of isolates assessed by pulsed-field gel electrophoresis (PFGE).


RESULTS
574 patients (356 renal, 134 ICU and 84 oncology) were screened; 12 were colonised with VRE--nine renal inpatients, two having peritoneal dialysis or incentre haemodialysis, and one ICU patient. Nine isolates were Enterococcus faecalis (seven positive for vanB and two negative for all three resistance genes) and three were Enterococcus faecium (all positive for vanB). Eight were high-level gentamicin resistant. PFGE suggested genetic clonality between the index isolate and five other isolates from renal patients. No specific clinical practice was associated with VRE colonisation. Attempts to clear rectal carriage with oral ampicillin/amoxycillin or bacitracin were of limited success. Although antibiotic prescribing in the Renal Unit was generally consistent with defined protocols, use of vancomycin and third-generation cephalosporins has been further restricted.


CONCLUSIONS
Renal inpatients in our institution appear most at risk of VRE colonisation (4.6% overall) and therefore of VRE infection. Routine screening, especially of potentially high-risk patients, should be considered in major Australian hospitals.
Grayson
M L
ML
Infectious Disease and Clinical Epidemiology Department, Monash Medical Center, Melbourne, VIC. Lindsay.Grayson@med.monash.edu.au
Grabsch
E A
EA
Johnson
P D
PD
Olden
D
D
Aberline
M
M
Li
H Y
HY
Hogg
G
G
Abbott
M
M
Kerr
P G
PG
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D015169:Colony Count, Microbial; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy / Q000517:prevention & control*; D004352:Drug Resistance, Microbial / Q000235:genetics; D016983:Enterococcus / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development; D013293:Enterococcus faecalis / Q000187:drug effects / Q000235:genetics; D016984:Enterococcus faecium / Q000187:drug effects / Q000235:genetics; D005243:Feces / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control*; D006757:Hospital Units; D006801:Humans; D007674:Kidney Diseases / Q000382:microbiology; D008403:Mass Screening; D016522:Oncology Service, Hospital; D017063:Outcome Assessment, Health Care; D010406:Penicillins / Q000627:therapeutic use; D010530:Peritoneal Dialysis; D006435:Renal Dialysis; D012307:Risk Factors; D014640:Vancomycin / Q000627:therapeutic use*; D014739:Victoria
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D010406:Penicillins; C071437:VanA ligase, Bacteria; C079913:VanB protein, Enterococcus; C079914:VanC protein, Bacteria; D014640:Vancomycin; D019729:Carbon-Oxygen Ligases