Colonization and Infection With Multiple Nosocomial Pathogens Among Patients Colonized With Vancomycin-ResistantEnterococcus

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Abstract
Objective: To test the hypothesis that patients colonized with vancomycin-resistantEnterococcus(VRE) have a higher frequency of colonization or infection with other nosocomial pathogens than do patients who are not colonized with VRE.Design: A rectal swab culture survey was conducted to determine the point-prevalence of stool colonization with ceftazidime-resistant gram-negative bacilli in hospitalized patients with or without VRE stool colonization. For a 6-month period, the frequency ofClostridium difficilediarrhea and isolation of antibiotic-resistant (ie, ceftazidime-, piperacillin/tazobactam-, levofloxacin-, or trimethoprim/sulfamethoxazole-resistant) gram-negative bacilli, methicillin-resistantStaphylococcus aureus(MRSA), and non-albicansCandidaspecies from clinical specimens other than stool was examined.Setting: A Department of Veterans Affairs medical center.Patients: All patients hospitalized in the acute care facility and one nursing home unit during a 1-week period in February 2001.Results: VRE-colonized patients had a higher point-prevalence of rectal colonization with ceftazidime-resistant gram-negative bacilli than did patients not colonized with VRE (17% vs 4%;P= .026). During a 6-month period, the VRE-colonized patients were more likely to haveClostridium difficile–associated diarrhea (26% vs 2%;P= .001), MRSA infection (17% vs 4%;P= .017), or colonization or infection with gram-negative bacilli resistant to 4 different antibiotics.Conclusion: VRE-colonized patients in our institution have a higher frequency of colonization or infection with other nosocomial pathogens than do patients who are not colonized with VRE. This suggests that isolation measures implemented to control VRE could help limit the dissemination of other, coexisting pathogens.