Enterococci are facultative bacteria that are commensal to the gut microflora and are shed in human feces. Enterococci are associated with a variety of health conditions ranging from urinary tract infection to serious and life-threatening infections to humans such as sepsis, and endocarditis.
Vancomycin-resistant Enterococcus (VRE) can spread by direct contact and occasionally through contact with contaminated equipment or other surfacesFootnote 1. VRE infections occur most commonly among people in hospital with weakened immune systems, those who have been previously treated with vancomycin (or other antibiotics for long periods of time), those who have undergone surgical procedures, and those with medical devices such as urinary cathetersFootnote 1.
At a glance
- Stratified by facility type, VRE BSI rates remained highest in adult hospitals from 2018 to 2022, ranging from 0.35 to 0.42 infections per 10,000 patient days.
- Since 2018, the majority (99.3%) of VRE BSI isolates were identified as Enterococcus faecium; however 3 Enterococcus faecalis isolates were identified in 2018 and 1 each in 2020, 2021, and 2022.
- Nearly 1 in 3 (34%) hospitalized of patients with a VRE BSI die within 30 days of diagnosis (all-cause mortality).
Key findings
Indicators from the Healthcare System
The Canadian Nosocomial Infection Surveillance Program (CNISP) surveillance of VRE BSIs tracks both healthcare- and community-associated cases that are admitted to participating hospitals across Canada.
Between 2018 and 2022:
- VRE BSIs were predominantly healthcare-associated (HA); 90.1% of VRE BSI reported between 2018 and 2022 were acquired in a healthcare facility.
- The rate of HA-VRE BSI remained the highest in adult facilities compared to pediatric and mixed-patient facilities over the five-year period; HA-VRE BSI rates in adult facilities ranged from 0.35 to 0.42
infections per 10,000 patient days from 2018 to 2022.
- Overall VRE BSI rates increased by 5.9% from 2018 to 2022, from 0.34 to 0.36 infections per 10,000 patient days.
- The rate of HA-VRE BSI in mixed-patient facilities ranged from 0.10 to 0.20 infections per 10,000 patient days from 2018 to 2022.
- HA-VRE BSI rates in pediatric facilities were low, ranging from 0 to 0.25 infections per 10,000 patient days from 2018 to 2022.
Notes
- Source: Canadian Nosocomial Infection Surveillance Program (CNISP)
All-cause mortality
From 2018 to 2022, the rate of all-cause mortality in hospitalized patients with a VRE BSI remained high at 34%.
Trends in antimicrobial resistance
Between 2018 and 2022:
- Nearly all VRE bloodstream infection isolates exhibited resistance to ciprofloxacin.
- High-level gentamicin resistance decreased from 43.2% in 2018 to 18.8% in 2022.
- Low levels of resistance were detected for tigecycline (range 0.0% to 0.5%) and linezolid (range 0.7 to 3.0%).
- Daptomycin resistance dropped from 6.0% in 2018 to 2.0% by 2022.
Notes
- Source: Canadian Nosocomial Infection Surveillance Program (CNISP)
Equity and key populations
According to surveillance data and/or published literature on known health inequities and key populations of concern:
- In an international systematic review and meta-analysis of sex differences in VRE-BSI, 59% of patients with VRE-BSIs in pooled prevalence were male for a prevalence ratio of 1.4 male/female. Further studies are needed to assess what factors may contribute to sex differences in VRE-BSI burdensFootnote 2.
- In an Ontario study, secondary vancomycin resistant bloodstream infections have also been documented in Canada among people who inject drugs hospitalized for endocarditis. Secondary bloodstream infections overall in this population were associated with in-patient treatment and injecting drugs while hospitalized (without access to sterile injection equipment), while in-patient addiction treatment was associated with a significantly lower rate of new bloodstream infectionsFootnote 3.
Data sources and further reading
- The Canadian Nosocomial Infection Surveillance Program (CNISP) captures epidemiologic and linked microbiology data on select infections and antimicrobial resistant organisms from participating acute-care hospitals in Canada.
- Public Health Agency of Canada information pages
References