Control of Endemic Glycopeptide-Resistant Enterococci

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Abstract
Objective: To evaluate the epidemiology of, and control measures for, vancomycin-resistant Enterococcus (VRE) in a renal unit. Design: A 3-month, prospective, prevalence culture survey of patients on a 24-bed renal unit. Setting: A 975-bed community teaching hospital. Patients: Patients admitted to the renal unit over a 3-month period. Patients identified with VRE were each matched with four patients without VRE isolated over the study period. Interventions/Control Measures: Resistant-organism barrier precautions. To eradicate carriage of VRE, two patients with VRE stool colonization were treated with 5 days of oral doxycycline (100 mg twice per day) and rifampin (300 mg/day). Results: Seven patients with VRE (8 isolates) were identified. Five isolates were Enterococcus faecium (vancomycin MIC=16 to 256 μg/mL), two were Enterococcus faecalis (MICs=16 and 124 μg/mL), and one was Enterococcus gallinarum (MIC=8.0 μg/mL). Eradication of carriage with VRE was accomplished in two patients treated with doxycycline and rifampin. In the final 30 days of the culture survey and at 9 months, there were no further patients with VRE identified. Conclusions: Resistant-organism precautions and elimination of patient carriage may be useful measures for controlling the spread of low-prevalence endemic van-comycin-resistant Enterococcus.