title: Stool colonization with vancomycin-resistant enterococci in healthcare workers and their households.
abstract: OBJECTIVE
  To determine the prevalence of stool colonization with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) and their families.
  
  
  METHODS
  Prospective assessment of fecal colonization with VRE.
  
  
  METHODS
  A 603-bed, tertiary-care teaching hospital.
  
  
  METHODS
  Healthy volunteers recruited from hospital employees and their households were screened to exclude pregnancy, diabetes mellitus, immunosuppressive disorders, and recent use of antimicrobials.
  
  
  METHODS
  Self-obtained stool swabs were used to obtain cultures. Isolated enterococci were screened for vancomycin resistance and species were identified. Intra-household isolates were genotyped using pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  The participants (n = 228; age range, 28 days to 80 years) were from 137 households with and 91 without employees who had contact with patients. Enterococcus species were isolated from 127 stool specimens (55.7%). VRE were detected in 12 individuals, representing 6 E. casseliflavus, 5 E. faecium, and 1 E. gallinarum. VRE were more commonly isolated in employees who had contact with patients (5 of 52 vs 0 of 40; relative risk [RR], 1.9; 95% confidence interval [CI95], 1.5 to 2.2; P = .07) and their household members (10 of 137 vs 2 of 91; RR, 3.3; CI95, 0.7 to 14.8; P = .13). In 2 households (2 adults in a physician's household and an adult plus a child in a nurse's household) PFGE analysis demonstrated identical intra-household strains of vancomycin-resistant E. faecium.
  
  
  CONCLUSIONS
  VRE colonization was found in 5.3% of screened stools and was more prevalent in HCWs who had contact with patients and their households. Identical PFGE patterns between 2 employees who had contact with patients and their household members demonstrated probable intra-household spread. Although the mode of acquisition was uncertain, the association with employees who had contact with patients suggests possible occupational sources. These findings demonstrate the spread of VRE within the household and implicate occupational risk for its acquisition.
authors.affiliation: Medical Education Department, St John Hospital & Medical Center, Detroit, MI 48236, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Baran
authors.forename: Jambunathan
authors.initials: J
authors.lastname: Ramanathan
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Riederer
authors.forename: Riad
authors.initials: R
authors.lastname: Khatib
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D005190:Family; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008824:Michigan / Q000453:epidemiology; D010564:Personnel, Hospital; D015995:Prevalence; D011446:Prospective Studies; D020713:Vancomycin Resistance