Title:
Duration of colonization and risk factors for prolonged carriage of vancomycin-resistant enterococci after discharge from the hospital.

Abstract:
There are no available studies on the duration and risk factors of vancomycin-resistant enterococci (VRE) carriage after hospital discharge. In this study we investigated the duration of colonization with VRE and the risk factors for prolonged carriage in the outpatient clinic after discharge from the hospital.
The study took place from January 2008 to September 2009. Patients were included if they were identified as persistent VRE carriers by follow-up rectal swab or stool cultures in the outpatient setting, after discharge from the hospital without clearance of VRE. The probability of culture positivity and clearance was analyzed from the discharge date. Cox regression was performed to determine the risk factors for prolonged carriage. VRE clearance was defined as VRE-negative rectal (or stool) cultures on at least three consecutive occasions a minimum of 1 week apart.
One hundred twenty-seven patients were included in this study. Follow-up cultures were conducted for a median of 8.86 weeks (range 1-90 weeks) after hospital discharge. The median duration of culture positivity of VRE was 5.57 weeks (range 0-50.14 weeks). Ninety-six out of 127 patients (75.6%) showed the first negative culture result at a median time of 4.86 weeks (range 0-66 weeks) after discharge. Among these patients, 15 were lost to follow-up after the first negative culture and eight were lost after the second negative culture. Sixty-eight patients (53.5%) were confirmed to have clearance of VRE during follow-up in the outpatient clinic. The median time to clearance after discharge was 8.86 weeks (range 2-90 weeks). In the cleared cases, the median time to the first negative VRE culture result was 4.71 weeks (range 0-66 weeks). Ninety percent of patients showed the first negative culture result at 25 weeks and VRE clearance at 30 weeks after discharge. Surgery or antibiotic use during admission (p = 0.048 and p = 0.001, respectively), dialysis (p = 0.046), and discharge to a nursing home or other health care institution (p = 0.025) were independently associated with prolonged colonization with VRE.
The median duration of VRE colonization was 5.57 weeks after hospital discharge. In the cases with clearance during follow-up, the median time to clearance after discharge was 8.86 weeks. Risk factors for prolonged carriage were surgery, antibiotic use during admission, dialysis, and discharge to a nursing home or other health care institution. Therefore, patients with these risk factors should be managed more carefully to prevent transmission of VRE in the outpatient clinic.