Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Sep 27;8(9):e75658.
doi: 10.1371/journal.pone.0075658. eCollection 2013.

Trends and significance of VRE colonization in the ICU: a meta-analysis of published studies

Panayiotis D Ziakas  1 , Rachana Thapa, Louis B Rice, Eleftherios Mylonakis
Affiliations
Meta-Analysis

Trends and significance of VRE colonization in the ICU: a meta-analysis of published studies

Panayiotis D Ziakas et al. PLoS One. .

Abstract

Background: The burden and significance of vancomycin-resistant enterococci (VRE) colonization in the ICU is not clearly understood.

Methods: We searched PubMed and EMBASE up to May 2013 for studies reporting the prevalence of VRE upon admission to the ICU and performed a meta-analysis to assess rates and trends of VRE colonization. We calculated the prevalence of VRE on admission and the acquisition (colonization and/or infection) rates to estimate time trends and the impact of colonization on ensuing VRE infections.

Findings: Across 37 studies (62,959 patients at risk), the estimated prevalence of VRE on admission to the ICU was 8.8% (7.1-10.6). Estimates were more consistent when cultures were obtained within 24 hours from admission. The VRE acquisition rate was 8.8% (95% CI 6.9-11.0) across 26 evaluable studies (35,364 patients at risk). Across US studies, VRE acquisition rate was 10.2% (95% CI 7.7-13.0) and demonstrated significant decline in annual trends. We used the US estimate of colonization on admission [12.3% (10.5-14.3)] to evaluate the impact of VRE colonization on admission in overall VRE prevalence. We demonstrated that VRE colonization on admission is a major determinant of the overall VRE burden in the ICU. Importantly, among colonized patients (including admitted and/or acquired cases) the VRE infection rates vary widely from 0-45% (with the risk of VRE bacteremia being reported from 0-16%) and <2% among those without a proven colonization.

Conclusion: In summary, up to 10.6% of patients admitted in the ICU are colonized with VRE on admission and a similar percentage will acquire VRE during their ICU stay. Importantly, colonization on admission is a major determinant of VRE dynamics in the ICU and the risk of VRE-related infections is close related to colonization.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors confirm that the fact that EM is an academic editor for PLOS ONE does not alter their adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Forrest plot of studies included in the meta-analysis of VRE prevalence at ICU admission [individual study data (squares) and combined estimates (diamond)].
Figure 2
Figure 2. VRE colonization in the ICU.
A. Observed (dots) and fitted (line) VRE prevalence estimates (all studies), by study mid-year. B. Observed (dots) and fitted (line) VRE prevalence estimates (U.S.A. studies), by study mid-year. C. Observed (blue dots), predicted (green dots) VRE acquisition estimates and quadratic fit (line) across U.S.A. studies. Data plotted by study mid-year.
Figure 3
Figure 3. Simulation of VRE endemic prevalence using US admission prevalence estimates to graphically demonstrate the amplifying effect of VRE admission prevalence.
A. for an effective reproductive number R(p,q)=0.9 B. for an effective reproductive number R(p,q)=0.5.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Sandiumenge A, Rello J (2012) Ventilator-associated pneumonia caused by ESKAPE organisms: cause, clinical features, and management. Curr Opin Pulm Med 18: 187-193. doi:10.1097/MCP.0b013e328351f974. PubMed: 22366995. - DOI - PubMed
    1. Doyle JS, Buising KL, Thursky KA, Worth LJ, Richards MJ (2011) Epidemiology of infections acquired in intensive care units. Semin Respir Crit Care Med 32: 115-138. doi:10.1055/s-0031-1275525. PubMed: 21506049. - DOI - PubMed
    1. Freire-Moran L, Aronsson B, Manz C, Gyssens IC, So AD et al. (2011) Critical shortage of new antibiotics in development against multidrug-resistant bacteria-Time to react is now. Drug Resist Update 14: 118-124. doi:10.1016/j.drup.2011.02.003. PubMed: 21435939. - DOI - PubMed
    1. de Kraker ME, Jarlier V, Monen JC, Heuer OE, van de Sande N et al. (2012) The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin Microbiol Infect. - PubMed
    1. Ramsey AM, Zilberberg MD (2009) Secular trends of hospitalization with vancomycin-resistant enterococcus infection in the United States, 2000-2006. Infect Control Hosp Epidemiol 30: 184-186. doi:10.1086/593956. PubMed: 19125679. - DOI - PubMed

Publication types

Grants and funding

The authors have no support or funding to report.
  NODES
INTERN 2
twitter 2