Evaluation of the prevalence and risk factors for colonization by vancomycin-resistant Enterococcus among patients on dialysis.
BACKGROUND
Vancomycin-resistant Enterococcus (VRE) has been reported among long-term dialysis patients, although risk factors for VRE colonization are not well defined. This study aims to appraise the prevalence and risk factors for VRE colonization among patients on long-term dialysis therapy, as well as the mechanisms for dissemination of vancomycin resistance.


METHODS
This is a cross-sectional survey of 320 patients on long-term dialysis therapy at 2 hospitals of the Federal University of São Paulo from June 2001 to March 2003. Fecal samples were collected from each patient once a week for 1 month. Samples with positive test results for VRE were submitted to molecular typing through automated ribotyping.


RESULTS
VRE prevalence was 14.4%. There were significant associations between VRE and dialysis type (hemodialysis, P = 0.04), number of hospitalizations (P = 0.03), low hemoglobin level (P = 0.03), and leukocytosis (P = 0.05). Among samples with VRE (n = 56), 25% were Enterococcus faecium; 10.7%, Enterococcus casseliflavus; 57.1%, Enterococcus gallinarum; and 3.6%, Enterococcus faecalis. All samples isolated were sensitive to teicoplanin, except for E faecium samples, which were strongly resistant, although 9 of 14 patients with this isolate presented the same ribogroup (111-S-4). Typing of 6 samples from 8 dialysis patients with E gallinarum was performed, showing a predominant ribogroup (112-S-4).


CONCLUSIONS
Hospital environment, hemodialysis, anemia, and leukocytosis appear to be associated with VRE colonization. These results suggest that dissemination of these bacteria among patients on long-term dialysis therapy may be taking place.
Barbosa
Dulce
D
Department of Nursing, Division of Nursing in Infectology, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil. dulce@denf.epm.br
Lima
Lidimara
L
Silbert
Suzane
S
Sader
Hélio
H
Cendoroglo
Miguel
M
Draibe
Sergio
S
Camargo
Luis
L
Vianna
Lucila
L
Belasco
Angelica
A
Sesso
Ricardo
R
D000368:Aged; D015373:Bacterial Typing Techniques; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D006306:Health Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000382:microbiology / Q000628:therapy; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010530:Peritoneal Dialysis; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D020713:Vancomycin Resistance