BACKGROUND: Vancomycin-resistant enterococci (VRE) have been important pathogen of nosocomial infections and isolated most commonly from urine specimens. However, the clinical significance of VRE bacteriuria remains unknown. The objectives of this study are to describe the frequency, related factors and outcomes of VRE bacteriuria, and to compare epidemiologic data and outcomes between the subgroups: symptomatic urinary tract infection (UTI), asymptomatic bacteriuria, and colonization. MATERIALS AND METHODS: For patients with urine culture positive for VRE between August 1, 2002 and June 30, 2005, we collected clinical data and performed a retrospective analysis. According to Centers for Disease Control and Prevention (CDC), patients were classified as symptomatic UTI, asymptomatic bacteriuria, colonization and undetermined. RESULTS: Total 144 episodes (2.88%), in 58 patients, of 5,008 urine specimens were positive for VRE during the study period. Frequency of antimicrobial exposure history, especially 3rd generation cephalosporin, indwelling urinary catheter, and ICU stay at the time of culture was high in patients with VRE bacteriuria. In VRE bacteriuria, symptomatic UTI was only 24.5%. Instead the majority of the patients (71.4%) was colonized in urine with VRE or had asymptomatic bacteriuria. In comparison between symptomatic UTI group and combined group of asymptomatic bacteriuria and colonization, most demographic data and clinical features including hospital day and mortality had no significant difference except one, male sex. CONCLUSION: Most patients with VRE bacteriuria were classified as asymptomatic bacteriuria and colonization and only one-fourth of patients with VRE bacteriuria require antibiotic therapy. Therefore, clinicians should decide to initiate antibiotic therapy after consideration of clinical significance of VRE bacteriuria.
Bacteriuria* ; Centers for Disease Control and Prevention (U.S.) ; Colon ; Cross Infection ; Enterococcus ; Epidemiology* ; Humans ; Male ; Mortality ; Retrospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Vancomycin Resistance

BACKGROUND: Vancomycin-resistant enterococci (VRE) have been important pathogen of nosocomial infections and isolated most commonly from urine specimens. However, the clinical significance of VRE bacteriuria remains unknown. The objectives of this study are to describe the frequency, related factors and outcomes of VRE bacteriuria, and to compare epidemiologic data and outcomes between the subgroups: symptomatic urinary tract infection (UTI), asymptomatic bacteriuria, and colonization. MATERIALS AND METHODS: For patients with urine culture positive for VRE between August 1, 2002 and June 30, 2005, we collected clinical data and performed a retrospective analysis. According to Centers for Disease Control and Prevention (CDC), patients were classified as symptomatic UTI, asymptomatic bacteriuria, colonization and undetermined. RESULTS: Total 144 episodes (2.88%), in 58 patients, of 5,008 urine specimens were positive for VRE during the study period. Frequency of antimicrobial exposure history, especially 3rd generation cephalosporin, indwelling urinary catheter, and ICU stay at the time of culture was high in patients with VRE bacteriuria. In VRE bacteriuria, symptomatic UTI was only 24.5%. Instead the majority of the patients (71.4%) was colonized in urine with VRE or had asymptomatic bacteriuria. In comparison between symptomatic UTI group and combined group of asymptomatic bacteriuria and colonization, most demographic data and clinical features including hospital day and mortality had no significant difference except one, male sex. CONCLUSION: Most patients with VRE bacteriuria were classified as asymptomatic bacteriuria and colonization and only one-fourth of patients with VRE bacteriuria require antibiotic therapy. Therefore, clinicians should decide to initiate antibiotic therapy after consideration of clinical significance of VRE bacteriuria.
Bacteriuria* ; Centers for Disease Control and Prevention (U.S.) ; Colon ; Cross Infection ; Enterococcus ; Epidemiology* ; Humans ; Male ; Mortality ; Retrospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Vancomycin Resistance

We report on the investigations and interventions conducted to contain an extended outbreak of Serratia marcescens bacteriuria that lasted for years in a neurosurgical intensive care unit (NSICU). A case-control study was performed to identify the risk factors for S. marcescens acquisition in urine. In case patients, urine sampling for tests and central venous catheterization were performed more frequently before the isolation of S. marcescens. Case patients were more frequently prescribed third-generation cephalosporins. Adherence to hand antisepsis was encouraged through in-service educational meetings and infection control measures, especially concerning the manipulation of indwelling urinary catheters, were intensified. The outbreak persisted despite the reinforcement of infection control measures. However, no patient has newly acquired the organism in the NSICU since December 2004. Multiple factors, including inadequate infection control practices and inappropriate antimicrobial usage, possibly contributed to the persistence of this S. marcescens outbreak. Healthcare workers should consistently follow infection control policies to ensure quality care.
Serratia Infections/*epidemiology/*prevention & control/transmission ; Risk Factors ; Risk Assessment/*methods ; Population Surveillance ; Neurosurgery/*statistics & numerical data ; Middle Aged ; Male ; Korea/epidemiology ; Intensive Care Units/*statistics & numerical data ; Infection Control/methods/statistics & numerical data ; Incidence ; Humans ; Follow-Up Studies ; Female ; Disease Transmission, Horizontal/prevention & control/statistics & numerical data ; Disease Outbreaks/prevention & control/statistics & numerical data ; Case-Control Studies ; Bacteriuria/*epidemiology/*prevention & control

We report on the investigations and interventions conducted to contain an extended outbreak of Serratia marcescens bacteriuria that lasted for years in a neurosurgical intensive care unit (NSICU). A case-control study was performed to identify the risk factors for S. marcescens acquisition in urine. In case patients, urine sampling for tests and central venous catheterization were performed more frequently before the isolation of S. marcescens. Case patients were more frequently prescribed third-generation cephalosporins. Adherence to hand antisepsis was encouraged through in-service educational meetings and infection control measures, especially concerning the manipulation of indwelling urinary catheters, were intensified. The outbreak persisted despite the reinforcement of infection control measures. However, no patient has newly acquired the organism in the NSICU since December 2004. Multiple factors, including inadequate infection control practices and inappropriate antimicrobial usage, possibly contributed to the persistence of this S. marcescens outbreak. Healthcare workers should consistently follow infection control policies to ensure quality care.
Serratia Infections/*epidemiology/*prevention & control/transmission ; Risk Factors ; Risk Assessment/*methods ; Population Surveillance ; Neurosurgery/*statistics & numerical data ; Middle Aged ; Male ; Korea/epidemiology ; Intensive Care Units/*statistics & numerical data ; Infection Control/methods/statistics & numerical data ; Incidence ; Humans ; Follow-Up Studies ; Female ; Disease Transmission, Horizontal/prevention & control/statistics & numerical data ; Disease Outbreaks/prevention & control/statistics & numerical data ; Case-Control Studies ; Bacteriuria/*epidemiology/*prevention & control