Rectal culture screening for vancomycin-resistant enterococcus in chronic haemodialysis patients: false-negative rates and duration of colonisation

• Published in: The Journal of hospital infection 2011-10, Vol.79 (2), p.147-150
• Main Authors: Park, I, Park, R.W, Lim, S.-K, Lee, W, Shin, J.s, Yu, S, Shin, G.-T, Kim, H
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacteriological Techniques - methods; Biological and medical sciences; Culture Media; Emergency and intensive care: renal failure. Dialysis management; End-stage renal disease; Enterococcus; Enterococcus - drug effects; Enterococcus - isolation & purification; False Negative Reactions; Female; Gastrointestinal Diseases - epidemiology; Gastrointestinal Diseases - microbiology; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Haemodialysis; Humans; Infectious Disease; Infectious diseases; Intensive care medicine; Male; Mass Screening - methods; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prevalence; Rectum - microbiology; Renal Dialysis - adverse effects; Renal failure; Time Factors; Vancomycin Resistance; Vancomycin-resistant enterococci
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2011.04.011

Summary Infection or colonisation with vancomycin-resistant enterococci (VRE) is common in chronic haemodialysis (HD) patients. However, there is limited information on the duration of VRE colonisation or on the reliability of consecutive negative rectal cultures to determine the clearance of VRE in chronic HD patients. Chronic HD patients from whom VRE was isolated were examined retrospectively. Rectal cultures were collected more than three times, at least one week apart, between 1 June 2003 and 1 March 2010. The results of the sequential VRE cultures and patients’ data were analysed. Among 812 patients from whom VRE was isolated, 89 were chronic HD patients and 92 had three consecutive negative cultures. It took 60.7 ± 183.9 and 111.4 ± 155.4 days to collect three consecutive negative cultures in the 83 non-chronic haemodialysis patients and nine chronic HD patients, respectively ( P = 0.011). The independent risk factors for more than three negative sequential rectal cultures were glycopeptide usage [odds ratio (OR): 2.155; P = 0.003] and length of hospital stay (OR: 1.009; P = 0.001). After three consecutive negative rectal cultures, two of six chronic HD patients and 10 of 36 non-HD patients were culture positive again. In conclusion, a significant proportion of patients colonised with VRE cannot be detected by three-weekly rectal cultures, and the duration of VRE colonisation in chronic haemodialysis patients tends to be prolonged. These results may be contributing to the continued increase in the prevalence of VRE.