In order to determine the prevalence of vancomycin-resistant enterococci (VRE) in The Netherlands, 624 hospitalized patients from intensive care units or hemato-oncology wards in nine hospitals and 200 patients living in the community were screened for VRE colonization. Enterococci were found in 49% of the hospitalized patients and in 80% of the patients living in the community. Of these strains, 43 and 32%, respectively, were Enterococcus faecium. VRE were isolated from 12 of 624 (2%) and 4 of 200 (2%) hospitalized patients and patients living in the community, respectively. PCR analysis of these 16 strains and 11 additional clinical VRE isolates from one of the participating hospitals revealed 24 vanA gene-containing, 1 vanB gene-containing, and 2 vanC1 gene-containing strains. All strains were cross-resistant to avoparcin but were sensitive to the novel glycopeptide antibiotic LY333328. Genotyping of the strains by arbitrarily primed PCR and pulsed-field gel electrophoresis revealed a high degree of genetic heterogeneity. This underscores a lack of hospital-driven endemicity of VRE clones. It is suggested that the VRE in hospitalized patients have originated from unknown sources in the community. Enterococcus spp. have recently emerged as important nosocomial pathogens (35). According to the data from the National Nosocomial Infections Surveillance System, enterococci are the fourth leading cause of nosocomial infections in the United States (12). Enterococcal infections that have frequently been reported include urinary tract infections, bacteremia, endocarditis, intra-abdominal infections, and surgical wound infections (27). Enterococcus faecalis is commonly isolated from the human gastrointestinal tract, whereas Enterococcus faecium is less frequently isolated from that site (31). This latter species, however, is noted for its antimicrobial resistance. Vancomycin-resistant E. faecium (VREF) strains have emerged in a setting of increasing high-level resistance of enterococci to penicillins and aminoglycosides (28). During the last few years, nosocomial outbreaks due to VREF have been described (17, 25). The emergence of VREF has raised serious concerns (28), and in response, the Hospital Infections Control Practices Advisory Committee (HICPAC), in collaboration with the Centers for Disease Control and Prevention, has developed recommendations for preventing the spread of vancomycin-resistant enterococci (VRE) (18). Given the concern that vancomycin resistance genes may transfer from enterococci to Staphylococcus aureus, a phenomenon that has been observed in vitro (31), control measures have already been proposed, should vancomycin-resistant S. aureus strains eventually arise (10). MATERIALS AND METHODS Prevalence study. Five Dutch university hospitals in Rotterdam, Utrecht, Nijmegen, and Amsterdam and four regional teaching hospitals in Breda and Tilburg participated in the study. Six hundred twenty-four patients who were hospitalized in the following wards were screened for gastrointestinal carriage of VRE...