Vancomycin-resistant enterococci colonization among dialysis patients: a meta-analysis of prevalence, risk factors, and significance

Am J Kidney Dis. 2015 Jan;65(1):88-97. doi: 10.1053/j.ajkd.2014.05.016. Epub 2014 Jul 17.


Background: Vancomycin-resistant enterococci (VRE) have become important nosocomial pathogens causing outbreaks worldwide. Patients undergoing dialysis represent a vulnerable population due to their comorbid conditions, frequent use of antibacterial agents, and frequent contact with health care settings.

Study design: Systematic review and meta-analysis of cross-sectional studies of screening for VRE colonization.

Setting & population: Patients receiving long-term dialysis treatment.

Selection criteria for studies: We performed a systematic literature search of PubMed and EMBASE databases to identify studies performing screening for VRE colonization among dialysis patients.

Predictor: Region, recent use of vancomycin or other antibiotics, previous hospitalization.

Outcomes: (1) VRE colonization and (2) rate of VRE infection among colonized and noncolonized individuals. Relative effects were expressed as ORs and 95% CIs.

Results: We identified 23 studies that fulfilled the inclusion criteria and provided data for 4,842 dialysis patients from 100 dialysis centers. The pooled prevalence of VRE colonization was 6.2% (95% CI, 2.8%-10.8%), with significant variability between centers. The corresponding number for North American centers was 5.2% (95% CI, 2.8%-8.2%). Recent use of any antibiotic (OR, 3.62; 95% CI, 1.22-10.75), particularly vancomycin (OR, 5.15; 95% CI, 1.56-17.02), but also use of antibiotics other than vancomycin (OR, 2.92; 95% CI, 0.99-8.55) and recent hospitalization (OR, 4.55; 95% CI, 1.93-10.74) significantly increased the possibility of a VRE-positive surveillance culture. Colonized patients had a significantly higher risk of VRE infection (OR, 21.62; 95% CI, 5.33-87.69) than their noncolonized counterparts.

Limitations: In 19 of 23 studies, a low percentage of dialysis patients (<80%) consented to participate in the screening procedure. 4 of 8 studies in which patients were followed up for more than 1 month reported VRE infections and only 5 of 23 studies provided extractable data for antibiotic consumption prior to screening.

Conclusions: VRE colonization is prevalent in dialysis centers. Previous antibiotic use, in particular vancomycin, and recent hospitalization are important predicting factors of colonization, whereas the risk of VRE infection is significantly higher for colonized patients.

Keywords: Vancomycin-resistant enterococci (VRE); colonization; end-stage renal disease (ESRD); hemodialysis; meta-analysis; nosocomial infection; peritoneal dialysis; renal dialysis; renal replacement therapy (RRT).

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Colony Count, Microbial / statistics & numerical data
  • Cross Infection* / epidemiology
  • Cross Infection* / etiology
  • Cross Infection* / microbiology
  • Cross-Sectional Studies
  • Hospitalization / statistics & numerical data
  • Humans
  • Kidney Failure, Chronic / therapy*
  • Prevalence
  • Renal Dialysis* / adverse effects
  • Renal Dialysis* / methods
  • Risk Factors
  • Vancomycin / therapeutic use*
  • Vancomycin-Resistant Enterococci / isolation & purification*


  • Anti-Bacterial Agents
  • Vancomycin