Background
The emergence of vancomycin-resistant Staphylococcus aureus (VRSA) poses significant challenges for antibiotic therapy. We characterized the
epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) co-colonization that may facilitate
resistance transfer and vancomycin-resistant S aureus emergence among nursing facility patients.
Methods
We cultured newly admitted patient hands, nares, oropharynx, groin, and perianal region
plus wounds and device insertion sites, if applicable, upon enrollment at day 14,
day 30, and monthly follow-up up to 6 months. Demographic, comorbidity, and antimicrobial
use data were collected. Functional status was assessed at each visit using the Physical
Self-Maintenance Scale. Multinomial logistic regression was performed to determine
factors predictive of co-colonization.
Results
Five hundred eight patients were enrolled, with an average follow-up time of 28.5days.
Prevalence of MRSA/VRE co-colonization, MRSA alone, and VRE alone was 8.7%, 8.9%,
and 23.4%, respectively. Independent predictors of co-colonization included indwelling
device use (odds ratio [OR] = 5.5 [2.2-13.7]), recent antibiotic use (OR = 2.5 [1.4-4.2]),
diabetes (OR = 1.9 [1.0-3.8]), and the presence of open wounds (OR = 1.9 [1.0-3.6]).
Conclusions
High rates of VRE are driving co-colonization with MRSA in nursing facilities. Indwelling
device use, recent antibiotic use, diabetes, and open wounds predicted patient co-colonization.
Key Words
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Article info
Publication history
Published online: November 27, 2018
Footnotes
Funding/support: This work was supported by the National Institutes of Health (RO1 AG041780 and K24 AG050685).
Conflicts of interest: None to report.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
