The changing epidemiology of vancomycin-resistant enterococci.
OBJECTIVE
To determine the distribution of vancomycin-resistant enterococci (VRE) cases in our hospital and those from outside of our hospital from 1993 through 1998.


METHODS
Weekly rectal surveillance was instituted whenever there were two or more cases present in the units. Cases were divided into acquired in our hospital, acquired outside of our hospital (VRE positive after and within 72 hours of admission, respectively), and indeterminate. Hospital cases were attributed to the originating ward or intensive care unit (ICU) if patients were noted to be positive within 72 hours of transfer.


RESULTS
From 1993 to 1998, the rate of VRE per 1,000 admissions increased threefold, from 3.2 to 9.8, for the hospital. VRE cases acquired outside of the hospital increased by approximately 5% per year (r = 0.87; P = .03). The rate of VRE per 1,000 admissions increased 1.7-fold in the ICUs and 3.6-fold in the wards. The ICUs had an average of 75.3 cases per year, with the number of new cases per year increasing by approximately 9 (r = 0.80; P = .028). In the wards, there were an average of 22.0 new cases per year, with a slight upward trend of 3 additional new cases per year (r = 0.69; P = .64). There was a highly significant increasing linear trend (P = .0007) for VRE colonization and infection.


CONCLUSIONS
Although VRE still predominate in the ICUs, cases originating from outside of our hospital and the wards are becoming more common. VRE colonization remained more frequent than infection.
University of Massachusetts Medical School, Department of Medicine, Division of Infectious Diseases and Immunology, Worcester 01655, USA.
Kwan Kew
KK
Lai
Sally A
SA
Fontecchio
Anita L
AL
Kelley
Stephen
S
Baker
Zita S
ZS
Melvin
D003428:Cross Infection / Q000453:epidemiology; D016983:Enterococcus / Q000187:drug effects* / Q000472:pathogenicity*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D012007:Rectum / Q000382:microbiology; D020713:Vancomycin Resistance