title: Epidemiology of vancomycin-resistant Enterococcus faecium under a selective isolation policy at an urban county hospital.
abstract: BACKGROUND
  We report our experience in a county hospital with the use of selective contact isolation for patients with vancomycin-resistant Enterococcus faecium (VREF). About 12% of patients with VREF are isolated for reasons such as draining wounds and uncontrolled diarrhea.
  
  
  METHODS
  Passive surveillance identified all inpatients (181) from 1995 to 1999 with cultures positive for VREF. Data were collected via electronic databases and from prospectively maintained infection control records. Isolates were typed with use of pulsed-field gel electrophoresis.
  
  
  RESULTS
  Nearly all patients (175/181) with VREF had been admitted at least 48 hours or had a history of previous hospitalization. Most patients (69%) had urine cultures positive for VREF without blood cultures positive for the organism. Only 12 of 127 (9.%) patients with complete data had VREF infection on the basis of receiving treatment and/or having more than 1 blood culture positive for VREF. After VREF became endemic, statistically significant increased prevalence was not detected via surveillance of clinical cultures nor sequential point-prevalence studies. Two major genotypes carrying vanB resistance genes were identified and persisted throughout the period studied. VREF persisted in individual patients up to 46 months.
  
  
  CONCLUSIONS
  The number of VREF infections in this facility has been low, despite appreciable colonization, for an extended period during which selective isolation was used.
authors.affiliation: University of California, San Francisco/San Francisco General Hospital, 94110, USA.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Winston
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Henry F
authors.initials: HF
authors.lastname: Chambers
authors.forename: Sue C
authors.initials: SC
authors.lastname: Felt
authors.forename: Judith I
authors.initials: JI
authors.lastname: Rosen
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: Margaret
authors.initials: M
authors.lastname: Wong
authors.forename: Lynn
authors.initials: L
authors.lastname: Steele
authors.forename: Julie Louise
authors.initials: JL
authors.lastname: Gerberding
authors.forename: Francoise
authors.initials: F
authors.lastname: Perdreau-Remington
mesh_terms: D000328:Adult; D015373:Bacterial Typing Techniques; D016984:Enterococcus faecium / Q000187:drug effects*; D005260:Female; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data; D007362:Intensive Care Units; D008297:Male; D010356:Patient Isolation; D012307:Risk Factors; D013997:Time Factors; D014640:Vancomycin / Q000494:pharmacology*; D020713:Vancomycin Resistance
chemical_list: D014640:Vancomycin