Epidemiology of bacteriuria caused by vancomycin-resistant enterococci—a retrospective study

Background: The epidemiology of vancomycin-resistant enterococcal (VRE) bacteriuria has not been previously described. Our objectives are to describe the frequency of VRE bacteriuria, to use strict definitions to distinguish symptomatic urinary tract infection (UTI) versus urine colonization without pyuria versus asymptomatic bacteriuria with pyuria, and to describe the outcomes of each group. Methods: We used a retrospective analysis of patients with VRE bacteriuria in an academic medical center. Results: During the 18-month study period, 98 of the 107 patients (92%) with urine cultures positive for VRE (23/10,000 admissions), had charts that were available for review. In 94 of 98 patients, the organism was Enterococcus faecium, and in only 4 was Enterococcus faecalis recovered. Thirty-seven patients were colonized with VRE; 21 patients had asymptomatic bacteriuria, and the status of 27 patients was not ascertainable. Thirteen patients had VRE UTIs with two associated bacteremias and one death. Patients with UTI versus patients without UTI were more likely to have an underlying malignancy (39% vs 9%, P = .014). Conclusion: The majority of urine cultures yielding VRE do not represent true infection, rather colonization or asymptomatic bacteriuria.