The Changing Epidemiology of Glycopeptide‐Resistant Enterococci in a Renal Unit

OBJECTIVES Glycopeptide‐resistant enterococci (GRE) have become well‐established nosocomial pathogens. Certain patient groups, such as renal patients, are at increased risk of GRE colonization and subsequent invasive disease. We sought to establish the current epidemiology of GRE within this patient group as well as other high risk groups in our institution and to ascertain whether the epidemiology had changed since the introduction of screening in 2001. METHODS All enterococcal isolates obtained from samples received from the renal unit, ICU, and oncology wards between 2001 and 2007 were reviewed, and information regarding glycopeptide usage on the renal unit was obtained from the pharmacy department. RESULTS There were 3,710 enterococcal isolates from the renal unit (GRE: 1,077), 1,464 from intensive care units (ICU; GRE: 203), and 857 from the oncology wards (GRE: 51). There was a 5‐fold increase in the percentage of enterococci displaying glycopeptide resistance from the renal unit between 2001/2002 and 2006/2007, with similar increases in resistance from the ICU and oncology wards. During this time, the predominant phenotype changed from VanB to VanA, resulting in an increased resistance profile. DISCUSSION Our results demonstrate that the number of isolates of GRE in our institution continues to rise yearly in renal patients. Owing to the change in phenotype, enterococci are displaying increased antibiotic resistance, resulting in a subsequent reduction in the therapeutic options available.