Ten percent of the bacterial enterococci isolated from these ICU patients were resistant to vancomycin. VRE were found more often at major teaching centers (12.6%) than at nonteaching hospitals (5.6%), and also more often at large hospitals (12.5%) than small ones (5.0%). Antibiotics were used the most in medical ICUs, medical–surgical units, and general surgical units and were used the least in coronary care units, neurosurgical units, and cardiothoracic ICUs (except for vancomycin itself, which was frequently used in neurosurgical and cardiothoracic ICUs). The factor most often associated with the presence of VRE in ICUs was the frequency of VRE in non-ICU inpatient areas of the hospital. The frequency of VRE was greater in ICUs with higher use of vancomycin. Use of another group of antibiotics known as third-generation cephalosporins was also significantly associated with the presence of VRE but only at the highest levels of use. In contrast, the frequency of finding VRE increased steadily as vancomycin use increased (rather than only at very high use levels).