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www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Vancomycin-resistant enterococci (VRE) emerged worldwide in recent years as life-threatening nosocomial pathogens. The objective of this study is to clarify the relationship of intensive care unit (ICU) acquired VRE with spatial and temporal exposure pressure at the patient level. Methods: A retrospective cohort study of patients admitted to the medical ICU at Mayo Clinic, Rochester from 2013 to 2016. Patients with positive VRE microbiology result before ICU admission were excluded. The enrolled patients were grouped into ICU VRE acquisition and no VRE according to the test result during ICU stay. Demographics, intervention, and hospital stay were abstracted from EMR and ICU datamart along with antibiotic use, temporal exposure pressure to prior VREpositive room occupant during past 15, 30, 90 days, and spatial exposure pressure to neighbors with VRE. Cox proportional hazard regression analysis was used to estimate the risk factor of ICU VRE acquisition. Results: During the study period, 10,452 patients were admitted to the ICU, with VRE incidence of 2.23% during ICU admission. After exclusion, 8955 were enrolled for analysis, of whom 91 (1.02%) acquired VRE in ICU. Patients acquired VRE had higher APACHE III (77.0 ± 25.6 vs. 64.3 ± 24.6), more frequently required mechanical ventilation (56.0% vs. 27.4%), longer hospital stay before ICU admission [0, (0, 2.2) vs. 0, (0, 0.1)], higher number of antibiotics [2 (1, 3) vs. 1 (0, 2)] than did those without VRE. The temporal exposure pressure and result are not significantly different between two groups. The spatial pressure for neighbors with present or historical VRE positivity was significantly higher in the ICU VRE acquisition group. Mechanical ventilation was an additional independent risk factor for ICU VRE acquisition. Conclusions: We found the VRE status of neighboring patients was a risk factor for ICU VRE acquisition. Increased attention to the historical VRE result during ICU admission is warranted. Further study of isolation procedures and implementation may be needed.