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 Original Articles |
| Rectal Surveillance Culture of Vancomycin-resistant Enterococci (VRE)
Colonization among Patients Hospitalized in the Intensive Care Unit (ICU) |
| Dong Rim Kim, M.D., Cheol Woong Yu, M.D., Hee Jin Cheong, M.D., Heung Jeong Woo, M.D.
Woo Joo Kim, M.D., Min Ja Kim, M.D., Seung Chul Park, M.D. and Sun Ju Choi, R.N.* |
| Department of Internal Medicine, Infection Control Unit*, Guro Hospital,
Korea University College of Medicine, Seoul, Korea |
Vol.31 Num.3 (p203~209)
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Background:VRE (vancomycin-resistant enterococci) have been an important nosocomial pathogen in the United States in the 1990s. VRE are usually multidrug-resistant and currently there is no effective antimicrobial agent for the treatment of such organisms. Recently, VRE have become an emerging nosocomial pathogen in Korea, but there have been few studies on the epidemiologic investigation of the infection or colonization of VRE among hospitalized patients with high risk factors. The purpose of this study was to determine the prevalence of rectal colonization of VRE among patients hospitalized in the intensive care unit (ICU), to study the risk factors for nosocomial acquisition of VRE, and to obtain the baseline data for controlling the spread of VRE infection within the hospital.
Methods:Between August 1 and October 12 (10 weeks) 1998, a prospective surveillance study was conducted in the ICU at Korea University, Guro Hospital. Surveillance rectal swab cultures for detecting VRE were obtained at weekly intervals among 93 patients admitted to the ICU during the study period. To obtain the VRE, rectal swab cultures were performed on Enterococcosel agar (BBL Microbiology Systems, Cockeysville, Md., USA) containing 6 μg/mL of vancomycin. Minimal inhibitory concentrations (MICs) of vancomycin and teicoplanin were determined by agar dilution method. For the genotyping of isolated VRE, detection of vanA, vanB, vanC1 and vanC2 gene by polymerase chain reaction was done. Patients harboring VRE were compared to patients who were not colonized with this organism to identify the risk factors associated with rectal colonization.
Results:The rectal colonization rate of VRE was 23.7% (22/93 patients), but no patients had VRE infection during the study period. Twenty-six strains of VRE, which were isolated from 22 patients, included 2 E. faecium, 18 E. gallinarum and 6 E. casseliflavus isolates. Two vancomycin-resistant E. faecium (VREF) isolates were vanA genotype. All E. gallinarum, and all E. casseliflavus isolates demonstrated vanC1 and vanC2 genotype, respectively. Risk factors for rectal colonization of VRE included diabetes, catheterization of arterial and central venous lines, and vancomycin usage.
Conclusion:This study demonstrated the low rectal colonization rate of clinically significant VREF (2.2%:2/93 patients) isolates among patients admitted to the ICU. This study suggests that maintaining HICPAC guidelines, restricted vancomycin usage and periodic surveillance in patients with high risk factors are important in preventing the emergence and spread of VRE infection among ICU patients in a university- affiliated hospital |
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Keywords : VRE, Rectal colonization, Intensive care unit, Surveillance |
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