Relapse and reacquisition of rectal colonization by vancomycin-resistant Enterococcus faecium after decolonization

Area of Science:

• Infectious Diseases
• Epidemiology
• Clinical Microbiology

Background:

• Vancomycin-resistant enterococci (VRE) pose a significant challenge in healthcare settings.
• Understanding the epidemiology of VRE colonization is crucial for infection control.
• Recurrent colonization requires investigation into transmission dynamics.

Purpose of the Study:

• To investigate the epidemiology of recurrent vancomycin-resistant enterococci (VRE) colonization.
• To compare primary and recolonization VRE strains in patients with documented clearance.
• To identify factors associated with VRE recolonization.

Main Methods:

• Retrospective study over 8 years.
• Analysis of hospitalized patients with recurrent VRE colonization.
• Pulsed-field gel electrophoresis (PFGE) and Tn1546 typing of VRE isolates.
• Review of patient medical records and hospital floor assignments.

Main Results:

• Fifteen patients experienced recurrent VRE colonization.
• Patients remaining on the same hospital floor were recolonized with indistinguishable VRE strains.
• Patients moved to different floors or discharged and readmitted acquired de novo colonization with distinct VRE strains.

Conclusions:

• Hospital environment and patient location are critical factors in VRE transmission.
• Maintaining patients on the same floor may facilitate endogenous reinfection with the same VRE strain.
• Interventions should focus on environmental cleaning and patient cohorting to prevent VRE recolonization.