Vancomycin-Resistant Enterococci: Screening Efficacy and the Risk of Bloodstream Infections in a Specialized...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Healthcare Epidemiology

Background:

• Vancomycin-resistant enterococci (VRE) rectal colonization is a major risk factor for VRE bloodstream infections (BSIs).
• VRE poses a significant threat in healthcare settings, necessitating effective detection and control strategies.
• Challenges exist in the rapid detection of VRE and its implications for patient care in infectious disease hospitals.

Purpose of the Study:

• To investigate the association between VRE rectal colonization and the incidence of VRE BSIs.
• To compare the efficacy of cultural screening versus molecular assays (MAs) for VRE detection.
• To highlight the clinical implications of VRE detection and patient care in an infectious disease hospital.

Main Methods:

• Retrospective analysis of VRE rectal swab screening using cultural methods and MAs from January 2020 to December 2023.
• Inclusion of adult patients with at least one rectal swab screening during hospitalization.
• Analysis of VRE-positive blood cultures and correlation with prior rectal swab results.

Main Results:

• VRE cultural screening showed a 15.4% positivity rate, primarily for *Enterococcus faecium*.
• MA revealed a higher prevalence (49.4%) with significant discordance compared to cultural testing.
• Patients with *E. faecium* intestinal colonization had a 9.78-fold increased risk of developing *E. faecium* BSI (p < 0.001).

Conclusions:

• A strong correlation exists between VRE rectal colonization and the risk of developing BSIs.
• Molecular testing demonstrates higher VRE detection rates and should be considered for inclusion in protocols.
• Effective screening, infection control, and ongoing surveillance for antimicrobial resistance are crucial.