Implications for Vancomycin-Resistant Enterococcus Colonization Associated With Clostridium Difficile Infections

Am J Infect Control. 2011 Apr;39(3):188-93. doi: 10.1016/j.ajic.2010.10.024.


Background: Vancomycin-resistant Enterococcus (VRE) colonization of the gastrointestinal tract shares similar risk factors with Clostridium difficile infection. We sought to elucidate the prevalence and risk factors of VRE colonization associated with C difficile infection.

Methods: All adult inpatients with C difficile infection from July 2006 to October 2006 were prospectively evaluated. All C difficile toxin-positive stool samples were screened for detection of VRE. Risk factors for VRE colonization were compared in patients with C difficile infection with and without VRE colonization.

Results: Of the 158 cases of C difficile infection evaluated, 88 (55.7%) involved VRE colonization. Independent risk factors for VRE colonization were admission from long-term care facilities (P = .013), dementia (P = .017), and hospitalization in the previous 2 months (P = .014). No statistically significant difference between C difficile infection cases with and without VRE colonization in terms of previous receipt (within 1 month) of antibiotics, including metronidazole and vancomycin, was found on multivariate analysis. C difficile infection cases with VRE colonization had a higher prevalence of coinfection with methicillin-resistant Staphylococcus aureus (P = .002) and Acinetobacter spp (P = .006).

Conclusion: VRE colonization was associated with >50% of C difficile infection cases and with a higher rate of coinfection with multidrug-resistant pathogens. Given the high rate of C difficile infection associated with VRE colonization, active surveillance of VRE in patients with C difficile infection is reasonable in high-risk settings.

MeSH terms

  • Acinetobacter Infections / epidemiology
  • Acinetobacter Infections / microbiology
  • Adult
  • Aged
  • Aged, 80 and over
  • Carrier State / epidemiology*
  • Carrier State / microbiology
  • Clostridium difficile / isolation & purification*
  • Enterococcus / drug effects
  • Enterococcus / isolation & purification*
  • Feces / microbiology
  • Female
  • Gram-Positive Bacterial Infections / epidemiology*
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / microbiology
  • Vancomycin Resistance*