Vancomycin-resistant Enterococci Colonization Without Clinical Infection in a High-acuity Pediatric Intensive Care Unit: Challenging the Rationale for Universal Surveillance.

BACKGROUND: Routine surveillance for vancomycin-resistant enterococci (VRE) colonization remains the standard practice in many intensive care units. However, in high-acuity pediatric intensive care units (PICUs), where clinical VRE infections are uncommon, universal screening may impose substantial financial and operational burdens with uncertain clinical benefits. This study evaluates the necessity and value of universal VRE surveillance by describing the clinical characteristics and risk profiles of asymptomatic VRE-colonized patients in a newly established, high-acuity, 54-bed PICU.

METHODS: This single-center, retrospective cohort study included all patients with positive admission or weekly rectal VRE screening cultures between October 2023 and October 2024. Demographic, clinical, microbiologic (including species identification) and outcome variables were analyzed.

RESULTS: Among 1270 PICU admissions, 74 patients (5.8%) were colonized with VRE; 42 (56.8%) were positive on admission and 32 (43.2%) acquired colonization during hospitalization. Enterococcus faecium was the predominant species (97.3%). Despite frequent exposure to recognized risk factors, including central venous catheters (79.7%), urinary catheters (77.0%), prolonged PICU stays and carbapenem exposure (62.2%), no patient developed a clinical VRE infection.

CONCLUSIONS: In this high-acuity PICU with robust infection prevention infrastructure, VRE colonization, including colonization with high-risk E. faecium strains, did not progress to clinical infection. These findings suggest that in high-acuity PICUs with established infection control excellence, the clinical yield of universal VRE screening may be marginal compared with its operational costs, supporting a transition toward targeted, risk-based surveillance.