Infection Control & Hospital Epidemiology
typing of VRE isolates from recolonizedHSCT patients revealed that in 55%of patients the newly detected strains differed fromthe origi- nal strains. Even without genomic evidence, the supposition that some
patients in our cohort were truly decolonized seems reasonable. Overall, 86% of our decolonized subcohort received antibiotics during their decolonized periods, yet 51 patients did not become recolonized, suggesting that these patients effectively cleared intes- tinalVREcarriage. The natural history ofVRE recolonization most likely involves other factors in addition to antibiotic exposure and bacterial transmission. The results of this study may not be generalizable to all patient
populations. Additional factors associated with initial VRE colonization such as immunosuppressive medications, proximity to other VRE patients, and invasive procedures were not evaluated. The variability of antibiotic administration could have influenced study outcomes. Changes in VRE testing procedures and targeted surveillance could have introduced selection bias. In summary, VRE colonization is tenacious and increases the
likelihood of VRE infection in immunocompromised patients. Infection control measures are essential, but their effectiveness is diminished by testing limitations and the complexity of nosoco- mial acquisition of VRE. We have shown that higher total antibi- otic days as a proportion of VRE decolonized days is associated with shorter time to VRE recolonization. VRE decolonization is a fragile state during which monitoring antimicrobial usage met- rics could aid in screening and isolation decisions among patients who appear to have become decolonized.
Author ORCIDs. Heather Y. Hughes, 0000-0002-9733-3172
Acknowledgments. We thank the staff of the NIH Clinical Center Microbiology Service for their critical contributions to this project.
Financial support. This research was supported by the NIH Clinical Center, and the intramural research program of the National Institute of Allergy and Infectious Diseases.
Conflicts of interest. Dr Milstone reports grants from Sage Products outside the submitted work. All other authors report no conflicts of interest relevant to this article.
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