Vancomycin-resistant enterococci colonization in patients at seven hemodialysis centers.
BACKGROUND
Vancomycin-resistant enterococci (VRE) are increasing in prevalence at many institutions, and are often reported in dialysis patients. We studied the prevalence of and risk factors for VRE at seven outpatient hemodialysis centers (three in Baltimore, MD, USA, and four in Richmond, VA, USA).


METHODS
Rectal or stool cultures were performed on consenting hemodialysis patients during December 1997 to April 1998. Consenting patients were recultured during May to July 1998 (median 120 days later). Clinical and laboratory data and functional status (1 to 10 scale: 1, normal function; 9, home attendant, not totally disabled; 10, disabled, living at home) were recorded.


RESULTS
Of 478 cultures performed, 20 (4.2%) were positive for VRE. Among the seven centers, the prevalence of VRE-positive cultures varied from 1.0 to 7.9%. Independently significant risk factors for a VRE-positive culture were a functional score of 9 to 10 (odds ratio 6.9, P < 0.001), antimicrobial receipt within 90 days before culture (odds ratio 6.1, P < 0.001), and a history of injection drug use (odds ratio 5.4, P = 0.004).


CONCLUSIONS
VRE-colonized patients were present at all seven participating centers, suggesting that careful infection-control precautions should be used at all centers to limit transmission. In agreement with previous studies, VRE colonization was more frequent in patients who had received antimicrobial agents recently, underscoring the importance of judicious antimicrobial use in limiting selection for this potential pathogen.
Tokars
J I
JI
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jit1@cdc.gov
Gehr
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Jarvis
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Anderson
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Armistead
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Miller
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ER
Parrish
J
J
Qaiyumi
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Arduino
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M
Holt
S C
SC
Tenover
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Westbrook
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Light
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D003428:Cross Infection / Q000453:epidemiology*; D016983:Enterococcus / Q000502:physiology*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors; D014481:United States; D020713:Vancomycin Resistance