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The changing epidemiology of vancomycin-resistant enterococci.
Kwan Kew Lai1, Sally A Fontecchio, Anita L Kelley
1University of Massachusetts Medical School, Department of Medicine, Division of Infectious Diseases and Immunology, Worcester 01655, USA.
Infection Control and Hospital Epidemiology
|May 3, 2003
Summary
Vancomycin-resistant enterococci (VRE) cases in hospitals are increasing, with a notable rise in cases acquired outside the hospital and in wards. VRE colonization remains more common than infection.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- Vancomycin-resistant enterococci (VRE) pose a significant challenge in healthcare settings.
- Understanding the distribution and trends of VRE is crucial for effective infection control.
Purpose of the Study:
- To analyze the distribution of vancomycin-resistant enterococci (VRE) cases within the hospital and those acquired externally between 1993 and 1998.
- To identify trends in VRE acquisition in different hospital units.
Main Methods:
- Rectal surveillance was implemented weekly when two or more VRE cases were identified.
- Cases were categorized as hospital-acquired, acquired outside, or indeterminate.
- Hospital-acquired cases were linked to the originating ward or ICU based on admission timing.
Main Results:
- Overall hospital VRE rates per 1,000 admissions tripled from 1993 to 1998.
- VRE cases acquired externally showed a consistent annual increase of approximately 5%.
- VRE rates increased 1.7-fold in ICUs and 3.6-fold in wards, with a significant upward trend in VRE colonization and infection.
Conclusions:
- While ICUs remain a primary site for VRE, external acquisitions and ward-based cases are increasing.
- VRE colonization is more prevalent than VRE infection.
- The study highlights evolving VRE epidemiology within the hospital.