Vancomycin-resistant enterococci in a general ICU of a teaching hospital in São Paulo

Objective

To evaluate the colonization rate and risk factors associated with vancomycin-resistant enterococci (VRE) in patients in a general ICU in a teaching hospital.

Methods

Rectal swabs were collected from June 2003 to November 2004, according to current recommendations of the infection control committee of our institution. Data from 94 patients were reviewed for analysis. The variables analyzed were age, time elapsed until ICU admission, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score and ICU outcome. The presence of intravascular catheters, urinary catheter, need of invasive mechanical ventilation (IMV) and dialysis were determined. Antimicrobial therapy (vancomycin, imipenen-cilastatin, cefepime and ceftriaxone) was also evaluated. Data analysis was performed with SPSS 12.0 and differences were considered significant when P < 0.05.

Results

From the 94 patients, 34 (36.17%) had positive VRE samples, all isolates being Enterococcus faecalis. Age, APACHE II score, time elapsed until ICU admission and mortality rate (26.5% vs 35%) were not related to VRE colonization. However, patients with positive samples had a longer ICU stay (38.24 days VRE-positive and 16.82 days non-VRE, P = 0.038). Neither the insertion of intravascular and urinary catheters nor the need for IMV and dialysis was associated with VRE colonization. In 57 patients who received vancomycin, 47.4% turned out to be VRE-positive.

Conclusion

A longer ICU length of stay predisposed to VRE colonization in a tertiary hospital. Clinical variables related to patient characteristics did not predispose to VRE colonization. The quality of medical and nursing care provided probably had greater influence, as could be expected in a teaching hospital.