Objective: Vancomycin Resistant Enterococci (VRE) colonisation in hospital patients has increased dramatically. It is common in renal failure patients. Our study aimed to determine whether VRE colonisation in renal patients influenced mortality, length of stay or subsequent VRE infection.
Method: Retrospective, case control study of 149 patients matched to 176 controls between 2000-2009. VRE colonised and infected patients were identified through the hospital microbiology database. Controls were selected from concurrent in patients who were swab negative during the same month as cases and matched on gender, age and dialysis modality. Demographic and morbidity data was obtained from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The main outcome variables were length of stay (LOS), number of admissions and mortality.
Results: No significant differences between VRE colonised and non-colonised patients in terms of demographics. VRE positive (colonised and infected) had significantly longer LOS compared to negative patients (7.2 vs 4.6 days, p<0.001). After adjustment for demographic and comorbidities, LOS remained significantly longer in VRE positive patients (3.59 days, 95% CI 2.17-5.01, p<0.001) ). Despite longer LOS, the mean number of admissions was not significantly different (10.5 controls vs 13.6 cases, p<0.39). The risk of death was not significantly increased in the cases compared to the controls (Odds Ratio 0.49, 95% CI 0.22-1.06, p=0.07).
Conclusion: VRE colonisation is a significant problem but causes few clinical infections. As colonisation requires contact precautions investigations and procedures are often delayed. There is no increased risk of death as opposed to non-colonised patients.