Low prevalence of vancomycin resistant enterococci colonization in intensive care patients in a Brazilian teaching hospital.

Vancomycin-resistant enterococci (VRE) are important pathogens involved in nosocomial infections. Colonization precedes infection and the number of colonized individuals is about 10 times higher than the number of infected patients. We examined VRE colonization in two intensive care units from October 2003 to June 2004. Perirectal swab specimens were obtained from all patients, starting on the 5th day after admission, and then weekly. A total of 249 swabs were obtained from 112 patients. Nine patients had VRE-positive swabs, giving a positive rate of 8.0%. The rate of patients colonized by V-R E. faecalis was 1.8% (n=2), 4.5% by V-R E. gallinarun (n=5) and 1.8% by V-R E. casseliflavus (n=2). No V-R E. faeciun was isolated. None of the patients that had been colonized by VRE were found to be infected by these pathogens. In summary, a low prevalence of colonization by VRE was found in our institution. Only a structured surveillance program, based on active searching, was able to detect this low number of cases.

Impact of antibiotic-resistant pathogens colonizing the respiratory secretions of patients in an extended-care area of the emergency department.

OBJECTIVE: To determine the incidence of acquired infection, and the incidence, risk factors, and molecular typing of multidrug-resistant bacterial organisms (MROs) colonizing respiratory secretions or the oropharynx of patients in an extended-care area of the emergency department (ED) in a tertiary-care university hospital. METHODS: A case-control study was conducted regarding risk factors for colonization with MROs in ED patients from July 1996 to August 1998. The most prevalent MRO strains were determined using plasmid and genomic analysis with PFGE. RESULTS: MROs colonized 59 (25.4%) of 232 ED patients and 173 controls. The mean ED length of stay for the 59 cases was 13.9 days versus 9.8 days for the 173 controls. The mean length of stay prior to the first isolation of MROs was 9.9 days. MRO species included Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa. The rate of hospital-acquired infection was 32.7 per 1,000 ED patient-days. The case fatality rate was significantly higher for cases. Univariate analysis identified mechanical ventilation, nebulization, nasogastric intubation, urinary catheterization, antibiotic therapy, and number of antibiotics as risk factors for MRO colonization. Multivariate regression analysis found that mechanical ventilation and nasogastric intubation independently predicted MRO colonization. Endemic clones were identified by PFGE in ED patients and were also found in patients in other parts of the hospital. CONCLUSIONS: Prolonged stay in the ED posed a risk for colonization with MROs and for contracting nosocomial infections, both of which were associated with increased mortality. Patients colonized with antibiotic-resistant A. baumannii may serve as a reservoir for spread in this hospital.

Low prevalence of vancomycin resistant enterococci colonization in intensive care patients in a Brazilian teaching hospital

Vancomycin-resistant enterococci (VRE) are important pathogens involved in nosocomial infections. Colonization precedes infection and the number of colonized individuals is about 10 times higher than the number of infected patients. We examined VRE colonization in two intensive care units from October 2003 to June 2004. Perirectal swab specimens were obtained from all patients, starting on the 5th day after admission, and then weekly. A total of 249 swabs were obtained from 112 patients. Nine patients had VRE-positive swabs, giving a positive rate of 8.0 percent. The rate of patients colonized by V-R E. faecalis was 1.8 percent (n=2), 4.5 percent by V-R E. gallinarun (n=5) and 1.8 percent by V-R E. casseliflavus (n=2). No V-R E. faeciun was isolated. None of the patients that had been colonized by VRE were found to be infected by these pathogens. In summary, a low prevalence of colonization by VRE was found in our institution. Only a structured surveillance program, based on active searching, was able to detect this low number of cases.