Abstract
Vancomycin-resistant enterococci (VRE) are important hospital pathogens and have become increasingly common in patients admitted to the intensive care unit (ICU). To determine the incidence and the risk factors associated with VRE colonisation among ICU patients, active surveillance cultures for VRE faecal carriages were carried out in patients admitted to the ICU of the University Hospital of Uberlândia, Minas Gerais, Brazil. Risk factors were assessed using a case-control study. Seventy-seven patients (23.1%) were found to be colonised with vanC VRE and only one patient (0.3%) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1%) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VRE-colonised patients are a potential epidemiologic reservoir of resistance genes.
Highlights
Vancomycin-resistant enterococci (VRE) have emerged worldwide as important nosocomial pathogens
From 333 patients included in the study, 78 (23.4%) were VRE-colonised (18.3/1,000 patientsday) and 35.9% (28/78) of these VRE-colonised patients had acquired the infection in the intensive care unit (ICU)
We observed that 64.1% (50/78) were already colonised with VRE upon ICU admission, including 46% (23/50) who were transferred from general wards and 54% (27/50) who were from outside of the hospital
Summary
Vancomycin-resistant enterococci (VRE) have emerged worldwide as important nosocomial pathogens. Glycopeptide resistance in enterococci is associated with diverse phenotypes (Werner et al 2008) and their resistance to several antimicrobial agents, whether intrinsic (low-level resistance to penicillin, cephalosporins and aminoglycosides) or acquired (resistance to glycopeptides and high concentrations of aminoglycosides), is of great concern (Metallidis et al 2006). The most infectious cases are associated with Enterococcus faecalis and Enterococcus faecium; in these species, the presence of vanA and vanB genes that encode high-level vancomycin resistance is of great concern due to their spread worldwide (Mazuski 2008). Despite higher rates of vanC VRE colonisation, the risk factors for colonisation by enterococci of this phenotype have not been identified (Neves et al 2009)
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