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September 1987

High-Level Aminoglycoside-Resistant Enterococci: Colonization of Nursing Home and Acute Care Hospital Patients

Author Affiliations

From the Divisions of Infectious Diseases (Drs Zervos, Schaberg, and Kauffman) and Geriatrics (Dr Terpenning and Ms Therasse), Department of Internal Medicine, the Health Services Research and Development Service, Veterans Administration Medical Center (Ms Medendorp), and the University of Michigan Medical School, Ann Arbor.

Arch Intern Med. 1987;147(9):1591-1594. doi:10.1001/archinte.1987.00370090069013

• Enterococci with high-level resistance (HLR) to gentamicin sulfate and other aminoglycosides have emerged as pathogens in recent years. More than half of all current isolates of enterococci at the Ann Arbor (Mich) Veterans Administration (VA) Medical Center are HLR strains. We determined the rate of colonization with HLR enterococci in patients in the acute care hospital, the attached nursing home, and a private nursing home. We also studied the factors related to colonization and the molecular relatedness of strains of HLR enterococci in these settings. In the VA facilities, 47.4% of patients in the nursing home and 36.1% of patients in the acute care hospital were colonized, compared with a 4.3% colonization rate in the private nursing home. Intravenous or Foley catheters and bedridden status were associated with colonization in the acute care setting; the need for advanced nursing care and prior antibiotic therapy were associated with colonization in the nursing home. Environmental surfaces were contaminated with HLR enterococci in both VA settings. Plasmid analysis of HLR strains revealed identity between both patient and environmental strains in the nursing home care unit and the acute care hospital. Nursing home patients, with their high rate of colonization with HLR enterococci and their frequent movement into the acute care hospital, may play a role as a reservoir for subsequent transmission of HLR enterococci.

(Arch Intern Med 1987;147:1591-1594)