[Table of Contents]

Canada Communicable Disease Report - Supplement
Volume: 23S8
December 1997

INFECTION CONTROL GUIDELINES

Preventing the Spread of Vancomycin-Resistant Enterococci (VRE) in Canada

Epidemiology of VRE

Enterococcus species are now recognized as important nosocomial pathogens. They have emerged as the second or third most common cause of nosocomial infections^(2,3) in recent reports from the National Nosocomial Infections Surveillance (NNIS) system at the U.S. Centers for Disease Control and Prevention (CDC). Between 1989 and 1993 there was a 23-fold rise in VRE infection, from 0.3% to 7.9% of nosocomial enterococcal infections reported to the NNIS system⁽⁴⁾. The increase was due mainly to a rise from 0.4% to 13.6% of VRE infection in intensive care units. The presence of VRE in the hospitals reporting to the NNIS system was associated with a size of 200 beds or more and a university affiliation⁽⁴⁾. Since the automated procedures used in many clinical laboratories do not efficiently detect vancomycin resistance, concerns have been raised that moderate vancomycin resistance has been unrecognized in many U.S. health care facilities. The prevalence of VRE has increased in Europe over the past 10 years since being identified in 1986^(5,6).

The epidemiology of VRE in Canada has not been fully elucidated. The first isolates, from two patients, were reported in 1993⁽⁷⁾. Although sporadic reports of small numbers of colonized and/or infected patients have been made⁽⁸⁾, the first outbreak of VRE in Canada occurred in the autumn of 1995⁽⁹⁾ and involved 38 patients, the majority of whom were receiving dialysis. In 1996, a survey of the Canadian Hospital Epidemiology Committee (CHEC) members, representing 21 health care facilities across Canada, indicated that 12 (57%) had previously conducted surveillance for VRE and 4 institutions had identified VRE, in a total of 37 patients⁽¹⁰⁾. Since this survey, increasing numbers of Canadian acute care facilities have reported isolation of VRE in patients. The prevalence of VRE within Canadian health care facilities should be further defined with the completion of the National VRE Point Prevalence Project and the establishment of the National VRE Sentinel Hospital Surveillance Program.

[Previous] [Table of Contents] [Next]