title: Dissemination of vancomycin-resistant enterococci among haemodialysis patients in Athens, Greece.
abstract: OBJECTIVE
  Vancomycin-resistant enterococci (VRE) may colonize haemodialysis patients, but their epidemiology in this population is not well defined. Within the few last years, VRE strains have emerged and are increasingly isolated in the nosocomial environment in Greece, but colonization of dialysis patients has never been evaluated before. This study sought to determine the epidemiology of VRE colonization within this high-risk population and define the risk factors.
  
  
  METHODS
  During a 4 month period, rectal swabs or faecal specimens were collected from 334 consecutive outpatients, who were treated at four independent dialysis units located in the same area of Athens and referring patients to the same local hospital. The relatedness of isolates was defined by molecular typing, and demographic and clinical patient data were recorded.
  
  
  RESULTS
  Thirteen multiresistant Enterococcus faecium vanA strains were isolated corresponding to a colonization frequency of 3.9%. They were separated into seven clusters: type A (two strains), type B (six strains) and types C to G (one strain each). Type B strains originated from three units, while a single unit demonstrated four type B and two type A strains. Univariate statistical analysis revealed that prior hospitalization (P=0.001), prior administration of antimicrobials (P=0.026) and male gender (P=0.019) were associated with VRE colonization.
  
  
  CONCLUSIONS
  In Greece, haemodialysis patients are colonized with VRE at a low frequency. The predominance of one clone and its isolation from several units strongly indicate interfacility transmission of strains, most probably within a health care environment shared by all patients.
authors.affiliation: G. Papadakis Center for Nephrology, General Hospital of Nikaia, Pireus, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Kalocheretis
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Baimakou
authors.forename: Sinodi
authors.initials: S
authors.lastname: Zerbala
authors.forename: Joseph
authors.initials: J
authors.lastname: Papaparaskevas
authors.forename: Ioanna
authors.initials: I
authors.lastname: Makriniotou
authors.forename: Panayotis T
authors.initials: PT
authors.lastname: Tassios
authors.forename: Christos
authors.initials: C
authors.lastname: Iatrou
authors.forename: Evangelia
authors.initials: E
authors.lastname: Kouskouni
authors.forename: Loukia
authors.initials: L
authors.lastname: Zerva
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D016983:Enterococcus / Q000145:classification* / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D015995:Prevalence; D006435:Renal Dialysis; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C071437:VanA ligase, Bacteria; D019729:Carbon-Oxygen Ligases