# Vancomycin-Resistant Enterococcus Colonisation in the Patients of a Regional Spinal Cord Injury Unit in Northwest England, United Kingdom: Our Experience with Non-Isolation of VRE Colonised Patients

## TL;DR

This study examines VRE colonization in a spinal injury unit where infected patients are not isolated, finding rising colonization rates but no infections.

## Contribution

The study provides real-world evidence on the impact of non-isolation of VRE-colonized patients in a resource-limited healthcare setting.

## Key findings

- 33 patients tested positive for VRE in a 12-month period, with colonization rates increasing over time.
- No patient developed a systemic VRE infection despite lack of isolation.
- No VRE infections were linked to baclofen pump implantation.

## Abstract

We reviewed vancomycin-resistant Enterococcus (VRE) colonisation of inpatients of a spinal cord injury centre. The centre consists of one single occupancy en suite room and ten multi-occupancy rooms where two to six patients stay in a cubicle. These patients share bathroom and toilet facilities. Active screening for VRE is performed by taking rectal swabs on admission of patients to the spinal unit. The patients, who are colonised with VRE, are not isolated due to constraints in resources. During a twelve-month period (April 2024 to April 2025), 33 patients tested positive for VRE. In April 2025, 17 of 40 in-patients tested positive for VRE. During the last six 12-month periods from 2019, the number of patients testing positive for VRE has shown an upward trend from 18 during 2019–2020 to 33 during 2024–2025. No patient developed systemic infection with VRE (blood stream infection, endocarditis, meningitis, intra-abdominal sepsis, infection of a spinal implant or baclofen pump) during the study period. Twelve patients underwent implantation of a baclofen pump during 2024–2025. No patient developed VRE infection from the implant. We believe that non-isolation of patients colonised with VRE may be a pragmatic approach in a resource-poor healthcare facility. It is possible that non-isolation could have contributed to an increase in the number of patients who became colonised with VRE. Attention should be paid to infection prevention measures including hand washing and environmental cleaning to prevent the spread of VRE colonisation of inpatients and VRE infection of at-risk patients, e.g., immune-compromised individuals.