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JAC Advance Access published online on October 21, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh450
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received June 21, 2004
Revised September 7, 2004
Accepted September 9, 2004

Original article

Dissemination of vancomycin-resistant enterococci among haemodialysis patients in Athens, Greece

Petros Kalocheretis 1, Eleftheria Baimakou 2, Sinodi Zerbala 1, Joseph Papaparaskevas 3, Ioanna Makriniotou 1, Panayotis T. Tassios 3, Christos Iatrou 1, Evangelia Kouskouni 2, and Loukia Zerva 3*

1 ‘G. Papadakis’ Center for Nephrology, General Hospital of Nikaia, Pireus, Greece
2 Laboratory of Microbiology and Biochemistry, Areteion Hospital, University of Athens, Athens, Greece
3 Department of Microbiology, Medical School, University of Athens, 75 Mikras Assias Street, Athens 11527, Greece

* To whom correspondence should be addressed.
Loukia Zerva, E-mail: louzerva{at}otenet.gr


  Abstract

Objectives: Vancomycin-resistant enterococci (VRE) may colonize haemodialysis patients, but their epidemiology in this population is not well defined. Within the few last years, VRE strains have emerged and are increasingly isolated in the nosocomial environment in Greece, but colonization of dialysis patients has never been evaluated before. This study sought to determine the epidemiology of VRE colonization within this high-risk population and define the risk factors.

Materials and methods: During a 4 month period, rectal swabs or faecal specimens were collected from 334 consecutive outpatients, who were treated at four independent dialysis units located in the same area of Athens and referring patients to the same local hospital. The relatedness of isolates was defined by molecular typing, and demographic and clinical patient data were recorded.

Results: Thirteen multiresistant Enterococcus faecium vanA strains were isolated corresponding to a colonization frequency of 3.9%. They were separated into seven clusters: type A (two strains), type B (six strains) and types C to G (one strain each). Type B strains originated from three units, while a single unit demonstrated four type B and two type A strains. Univariate statistical analysis revealed that prior hospitalization (P=0.001), prior administration of antimicrobials (P=0.026) and male gender (P=0.019) were associated with VRE colonization.

Conclusions: In Greece, haemodialysis patients are colonized with VRE at a low frequency. The predominance of one clone and its isolation from several units strongly indicate interfacility transmission of strains, most probably within a health care environment shared by all patients.

Keywords: epidemiology; colonization; surveillance cultures.
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