A hospital-based rectal swab culture survey to detect vancomycin-resistant enterococci: Utility and application

Objectives: To assess the prevalence of vancomycin-resistant enterococcal rectal colonization in a 750-bed hospital (including assessment of the impact of antibiotic use on prevalence) and to compare this method of surveillance to that of monitoring sterile body fluid cultures. Design: A rectal swab culture survey was conducted on a randomly chosen sample of 131 patients who were stratified by prior antibiotic use. Results: The rectal swab culture survey indicated that a minimum of 6.2% of patients were colonized with vancomycin-resistant enterococcal, whereas monitoring sterile body fluid cultures indicated that 0.4% of patients were infected or colonized with vancomycin-resistant enterococci. Oral vancomycin therapy, parenteral vancomycin therapy, and cephalosporin therapy (cefoxitin, ceftriaxone, and ceftazidime) were associated with significantly increased risk of vancomycin-resistant enterococcal rectal colonization. Conclusions: Periodic rectal swab culture surveys are more sensitive in detecting the prevalence of vancomycin-resistant enterococcal colonization and can provide strategic information to guide infection control activities. Restriction of oral and parenteral vancomycin therapy as well as restriction of cephalosporin therapy (cefoxitin, ceftriaxone, and ceftazidime) may contribute significantly to reducing the prevalence of vancomycin-resistant enterococcal colonization.