Evaluation of Asymptomatic Carriage of Vancomycin-resistant Enterococci in Acute Patients at a Veterans Affairs Medical Center

Background: Asymptomatic intestinal carriage of vancomycin-resistant Enterococcus (VRE) is common in many U.S. healthcare facilities. Patients with intestinal colonization with VRE are at risk for development of infections and are a potential source for transmission. 

Objective: To determine the prevalence of asymptomatic carriage of VRE in a Veterans Affairs Medical Center and to determine risk factors for colonization.

Methods: We performed a point-prevalence culture survey of 149 hospitalized patients with no previous clinical cultures positive for VRE. Rectal, skin (chest/abdomen, and groin) and environmental sites were cultured for VRE. Bivariate analysis and logistic regression were used to assess factors associated with VRE colonization.  

Results: Forty-four (30%) of the 149 patients were asymptomatic carriers of VRE. Among the rectal carriers, 25 (57%) had contamination of either skin and/or environment. On logistic regression analysis, prior antibiotic use in the last 3 months and increased length of stay were associated with asymptomatic carriage (P < 0.05). By bivariate analysis, incontinence, methicillin-resistant Staphylococcus aureus carriage and prior history of Clostridium difficile were also significant.

Conclusions: Asymptomatic carriage of VRE was common among patients in our institution. Most of these patients had skin and/or environmental contamination and could potentially contribute to transmission. Recent antibiotic use and increased length of stay were risk factors for carriage of VRE.