Vancomycin-resistant Enterococcus colonization before admission to the intensive care unit: a clinico-epidemiologic analysis

Abstract

Background: Asymptomatic vancomycin-resistant Enterococcus (VRE) colonization is known to precede actual infection. Since VRE was first isolated in Korea in 1992, the VRE isolation rate has rapidly increased in tertiary hospitals.

Methods: We performed a prospective observational study to estimate the prevalence of VRE colonization among inpatients at the time of intensive care unit (ICU) admission. From March through December 2007, rectal swab cultures were taken in all patients admitted to the ICU. We aimed to identify the risk factors for VRE colonization on admission.

Results: During the study period, 34 (4.4%) out of 780 patients were already colonized with VRE before ICU admission: 21 out of 323 patients from general wards (6.5%) and 13 out of 437 patients from outside the hospital (2.97%). VRE-colonized patients were more likely than uncolonized patients to have infectious diseases and to have been referred from outside hospitals (P < .01). Previous hospitalization (P = .01) and antibiotic exposure (P < .01) were risk factors for VRE colonization before ICU admission. Pulsed-field gel electrophoresis patterns were diverse. Initial VRE colonization correlated to poor prognosis.

Conclusion: VRE colonization rate was not negligible among newly admitted ICU patients, suggesting that an active surveillance program focusing on high-risk groups may be helpful.