Not all patients with vancomycin-resistant enterococci need to be isolated

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Epidemiology

Background:

• Vancomycin-resistant enterococci (VRE) outbreaks are a concern in healthcare settings.
• VRE genotype vanC strains are not typically associated with VRE outbreaks.
• Limited data exists on the risk of bloodstream infections in patients colonized with VRE genotype vanC.

Purpose of the Study:

• To estimate the risk of bloodstream infections in leukemia patients colonized with VRE genotype vanC.
• To evaluate the effectiveness of standard precautions versus contact isolation for vanC VRE colonization.
• To inform infection control policies for VRE genotype vanC in bone marrow transplant units.

Main Methods:

• Prospective rectal screening for VRE in a bone marrow transplant unit from 2000 to 2008.
• Molecular characterization of VRE isolates to determine genotype (vanA, vanB, vanC).
• Comparison of infection control policies: contact isolation for vanA/vanB VRE, standard precautions for vanC VRE.

Main Results:

• 290 vanC VRE isolates from 273 patients identified over 9 years.
• 98% of vanC VRE isolates were from rectal screening; none required specific treatment.
• Only 1 case (0.4%) of vanC VRE bloodstream infection occurred; no outbreaks were recorded.

Conclusions:

• Patients colonized with VRE genotype vanC do not require contact isolation.
• Implementing standard precautions for vanC VRE can save resources and improve patient care.
• Routine determination of VRE genotype is recommended in high-prevalence areas.