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Rectal swabs were cultured for VRE on selective media and analyzed via 16S ribosomal RNA gene sequencing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Ninety patients were sampled (340 longitudinal swabs). VRE positivity rose from 20% at ICU admission to a peak of 33% by ICU day 14 and then modestly declined to 31% by ICU day 30. Paralleling this, alpha diversity fell while Enterococcus relative abundance rose through ICU day 14 with both returning to baseline by ICU day 30. The median relative abundance of Enterococcus was 38% (interquartile range [IQR], 7.4%\u201375%) for VRE-positive samples compared to 0.01% (IQR, 0%\u201319%) for VRE-negative samples (rank-sum P &amp;lt; .01); 38 samples had \u226590% Enterococcus and 8 samples were 100% Enterococcus by sequencing. VRE was associated with lower alpha diversity (median Shannon index 1.90 [IQR, 0.89\u20132.66] if VRE positive versus 2.64 [IQR, 1.58\u20133.22] if VRE negative; P &amp;lt; .01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>VRE gut colonization peaked at ICU day 14 followed by a modest decline and was associated with low alpha diversity. Improved understanding of dynamic changes in the gut microbiome may facilitate successful future ICU interventions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trials Registration<\/jats:title>\n                  <jats:p>NCT03865706.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiaf194","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T07:41:34Z","timestamp":1744616494000},"page":"669-678","source":"Crossref","is-referenced-by-count":9,"title":["Gut Colonization With Vancomycin-Resistant <i>Enterococcus<\/i> Shapes the Gut Microbiome in the Intensive Care Unit"],"prefix":"10.1093","volume":"232","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5815-9717","authenticated-orcid":false,"given":"Heekuk","family":"Park","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Microbiome Core Facility, Department of Medicine, Columbia University Irving 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