Background
Given the known link between vancomycin-resistant Enterococcus faecalis (VREF) and vancomycin-resistant Staphylococcus aureus (VRSA), the recent increase in prevalence of VREF in southeast Michigan has raised
concerns about the presence of a large “community” reservoir of VREF. Efforts to control
its spread face some important challenges.
Methods
Patients with clinical isolates of community-onset (CO) VREF (cases) were compared
with matched uninfected controls (study 1) and patients with hospital-onset (HO) VREF
(study 2). Here, CO was defined as a hospital stay of ≤2 days before VRE isolation.
Results
Independent predictors for the isolation of CO-VREF compared with uninfected controls
were nonhome residence; chronic skin ulcers; previous invasive procedures/surgery;
exposure to cephalosporin, penicillin, and/or vancomycin; immunosuppressive status;
and the presence of indwelling devices. Independent predictors for isolation of CO-VREF
compared with HO-VREF included no stay in an intensive care unit in the previous 3 months
and recent hospitalization. VREF isolation from wounds and aminoglycoside exposure
were inversely associated with isolation of CO-VREF.
Conclusions
Health care–related exposures and antimicrobial exposures are risk factors for the
isolation of CO-VREF. Regional infection control practices are imperative in controlling
CO-VREF, in addition to the emergence and spread of VRSA.
Key Words
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References
- Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary.Clin Infect Dis. 2011; 52: 285-292
- Horizontal gene transfer and the genomics of enterococcal antibiotic resistance.Curr Opin Microbiol. 2010; 13: 632-639
- VanA-type vancomycin-resistant Staphylococcus aureus.Antimicrob Agents Chemother. 2009; 53: 4580-4587
Centers for Disease Control and Prevention. CDC reminds clinical laboratories and healthcare infection preventionists of their role in the search and containment ofvancomycin-resistant Staphylococcus aureus (VRSA). Available from: http://www.cdc.gov/HAI/settings/lab/vrsa_lab_search_containment.html. Accessed February 7, 2013.
- Dissemination of an enterococcus Inc18-like vanA plasmid associated with vancomycin-resistant Staphylococcus aureus.Antimicrob Agents Chemother. 2010; 54: 4314-4320
- Growing prevalence of vancomycin-resistant Enterococcus faecalis in the region with the highest prevalence of vancomycin-resistant Staphylococcus aureus.Infect Control Hosp Epidemiol. 2011; 32: 922-924
- Epidemiology of vancomycin-resistant enterococci in the community and the relevance of farm animals to human infection.J Hospital Infect. 1997; 37: 89-101
- Comparison of the clinical characteristics and outcomes associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant E faecium bacteremia.Antimicrob Agents Chemother. 2012; 56: 2452-2458
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Validation of a prognostic score in critically ill patients undergoing transport.Br Med J (Clin Res Ed). 1985; 291: 432-434
- Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function.JAMA. 1963; 185: 914-919
- Performance standards for antimicrobial susceptibility testing; nineteenth informational supplement. Approved standard M100-S19.Clinical and Laboratory Standards Institute, Wayne [PA]2009
- Vancomycin-resistant Staphylococcus aureus in the United States, 2002-2006.Clin Infect Dis. 2008; 46: 668-674
- Risk factors and outcomes for vancomycin-resistant Enterococcus bloodstream infection in children.Infect Control Hosp Epidemiol. 2010; 31: 1038-1042
- The incidence of and clinical variables associated with vancomycin-resistant enterococcal colonization in mechanically ventilated patients.Chest. 1999; 115: 1085-1091
- Acquisition of vancomycin-resistant enterococci in internal medicine wards.Am J Infect Control. 2009; 37: 111-116
- Wounds, functional disability, and indwelling devices are associated with cocolonization by methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in southeast Michigan.Clin Infect Dis. 2011; 53: 1215-1222
- Recovery of both vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus from culture of a single clinical specimen from colonized or infected patients.Infect Control Hosp Epidemiol. 2009; 30: 130-138
- The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida.Ann Intern Med. 2002; 136: 834-844
- Risk factors for acquiring vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus on a burn surgery step-down unit.J Burn Care Res. 2010; 31: 269-279
- Epidemiology of vancomycin-resistant Enterococcus faecalis: a case-case-control study.Antimicrob Agents Chemother. 2013; 57: 49-55
Article info
Publication history
Published online: September 09, 2013
Footnotes
A.M.O. and Y.L. contributed equally to this work.
K.S.K is supported by the National Institute of Allergy and Infectious Diseases (DMID protocol no. 10-0065). M.J.R is supported in part by National Institute of Allergy and Infectious Diseases (grant R21AI092055).
Conflict of interest: M.J.R. has received grant support, consulted for, or provided lectures for Clinical Therapeutics, Cubist Pharmaceuticals, and Forest Pharamaceuticals. None of the other authors has any conflicts of interest to disclose.
Identification
Copyright
© 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
