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Colonization with vancomycin-resistant enterococci in chronic hemodialysis patients
M C Roghmann1, J C Fink, L Polish
1University of Maryland School of Medicine, Baltimore, USA. mroghman@umaryland.edu
Summary
Vancomycin-resistant enterococcus (VRE) colonization is common in hemodialysis patients, particularly those with recent hospitalizations. However, VRE colonization does not increase mortality risk in these patients.
Area of Science:
- Infectious Diseases
- Nephrology
- Epidemiology
Background:
- Vancomycin-resistant enterococcus (VRE) is increasingly prevalent in dialysis populations.
- Risk factors for VRE colonization in hemodialysis patients are not well understood.
Purpose of the Study:
- To identify risk factors for VRE colonization in hemodialysis patients.
- To determine the association between VRE colonization and mortality or infection in this population.
Main Methods:
- Prospective surveillance and clinical cultures for VRE were performed on 168 hemodialysis patients.
- Demographic and clinical data, including comorbidities and hospitalization history, were collected.
- Patients were followed for mortality, hospitalization, and VRE infection.
Main Results:
- Sixteen patients had VRE detected on surveillance cultures, and nine had VRE on clinical cultures.
- VRE-positive patients had shorter time on hemodialysis before screening and more hospitalizations in the prior year.
- VRE colonization was associated with a higher risk of VRE infection but not increased all-cause mortality after adjusting for comorbidities.
Conclusions:
- VRE colonization is linked to recent hospitalization and shorter dialysis vintage, suggesting inpatient transmission.
- VRE colonization in hemodialysis patients does not independently increase mortality risk.
- Interventions to prevent VRE transmission in hospitals are crucial for this vulnerable population.