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Abstract
Background
Cross-transmission within hospitals has been considered a major source of vancomycin-resistant enterococci (VRE) acquisition. Inflow of VRE from outside hospitals may also be an important factor in South Korea.
Methods
An active-point surveillance for VRE colonization was performed in one medical ward of a 767-bed hospital using single rectal swabs or stool samples. The proportion of VRE detected within 48 h of admission was sought. Risk factors for VRE acquisition were analyzed. To confirm the persistence of VRE inflow outside a single point, the degree of yearly VRE inflow was assessed by passive surveillance of clinical specimens over 2 years in the hospital, each one year before and after the active surveillance.
Results
The active-point surveillance of 9 days resulted in 28 (28/72, 38.9%) VRE-positive patients, of whom nine (9/72, 12.5%) were patients were estimated to originate from outside the hospital. The duration of hospitalization and the use of antibiotics were significant risk factors for VRE colonization after admission, and the number of days from admission to first VRE positivity was a median of 8.5 (interquartile range, 2.7–15.0). During the 2 years, 213 patients were identified to be VRE-positive per clinical specimens with 95.5% of concurrent stool VRE, and 12.6% (27/213) were estimated to have acquired the infection from outside the hospital. This confirmed that the VRE inflow was continuous, but not transient or resembling an outbreak on one point.
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Figure 1.
(A) Results of active surveillance for vancomycin-resistant enterococci (VRE) by length of stay (LOS) and VRE-positivity. (B) Distributions of location before admission of the patients with VRE. LTCF, long-term care facility.
Table 1.
Characteristics of patients in a point VRE surveillance in one medical ward (N=72)
| Variable | VRE-negative (n=44) | VRE-positive (n=28) | P value | |
|---|---|---|---|---|
| Gender, male, n (%) | 26 (59.1) | 17 (60.7) | 0.545 | |
| Age, years (mean±SD) | 65.4±16.4 | 64.7±11.9 | 0.847 | |
| Underlying diseases, n (%) | ||||
| Diabetes mellitus | 21 (47.7) | 10 (35.7) | 0.224 | |
| Hypertension | 32 (72.7) | 17 (60.7) | 0.209 | |
| Chronic kidney disease | 14 (31.8) | 7 (25.0) | 0.365 | |
| Chronic liver disease | 2 (4.5) | 4 (14.3) | 0.154 | |
| COPD | 3 (6.8) | 0 (0) | 0.222 | |
| Solid tumor | 4 (9.1) | 5 (17.9) | 0.230 | |
| Hematologic malignancy | 0 (0) | 1 (3.6) | 0.389 | |
| Other* | 13 (29.5) | 12 (42.9) | 0.183 | |
| No comorbidity | 3 (6.8) | 1 (3.6) | 0.492 | |
| Duration of hospitalization, mean days (IQR) | 3.3 (1.0-4.0) | 13.7 (2.7-15.0) | 0.022 | |
| ≤48 h, n (%) | 27 (61.4) | 9 (32.1) | 0.016 | |
| ＞48 h, n (%) | 17 (38.6) | 19 (67.9) | - | |
| Route of admission, n (%) | ||||
| Transfer from LTCF | 4 (9.1) | 4 (14.3) | 0.703 | |
| Transfer from other hospitals | 3 (6.8) | 3 (10.7) | 0.672 | |
| Admission from community | 37 (84.1) | 21 (75.0) | 0.197 | |
| New admission | 3 (6.8) | 6 (21.4) | 0.140 | |
| In-hospital use of antibiotics | 18 (40.9) | 21 (75.0) | 0.005 | |
| Duration, mean days (IQR) | 1.2 (0-1.7) | 8.6 (0.2-10.7) | 0.008 | |
Table 2.
VRE-positive patients in clinical specimens during two years, one year each ‘before’ and ‘after’ the point surveillance
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