Abstract
BackgroundLittle is known about risk factors for subsequent infections among vancomycin resistant Enterococcus faecium (VREfm) colonizers, especially characterized by concordant pulsotypes (CP) of paired colonization and infection-related isolates.MethodsThis case-control study was conducted at a teaching hospital between 2011 and 2014. Targeted patients received active surveillance culture for VREfm by anal swabs at admission. Cases were those who developed VREfm infection within 180 days after colonization of VREfm. Controls were those colonized with VREfm without subsequent VREfm infection. CP were defined by similarities ≥86.7% using pulsed-field gel electrophoresis between paired colonization and infection-related isolates.ResultsNinety-seven cases and 194 controls were enrolled. By conditional multivariable logistic regression analysis, the risk factors for subsequent infection among VREfm colonizers were intensive care unit (ICU) admission (adjusted odds ratio [aOR], 9.32; 95% CI, 3.61–24.02), receipt of central venous catheters (CVC) (aOR, 3.38; 95% CI, 1.30–8.82), and utilization of third- and fourth-generation cephalosporins (aOR, 4.06; 95% CI, 1.79–9.20, and aOR, 5.32; 95% CI, 1.85– 10.29, respectively) (all P ≤ 0.01). Fifty-six (57.7%) of case patients belonged to the CP group, which were associated with ICU admission (aOR, 3.74; 95% CI, 1.38–10.13), and infection developing within 30 days after colonization (aOR, 3.34; 95% CI, 1.25–8.91).ConclusionsAmong VREfm colonizers, being admitted to ICU and receiving CVC or broad spectrum cephalosporins, were the risk factors for subsequent infections. These findings highlight the importance of conducting more strict infection control measures on specific groups of VREfm colonizers.
Highlights
Little is known about risk factors for subsequent infections among vancomycin resistant Enterococcus faecium (VREfm) colonizers, especially characterized by concordant pulsotypes (CP) of paired colonization and infection-related isolates
Ninetyseven (3.2%) VREfm colonized patients who had subsequent VREfm infections were defined as case patients
By conditional multivariable logistic regression, independent risk factors for developing subsequent infections among VREfm colonizers were intensive care unit (ICU) admission, receipt of central venous catheters (CVC), and utilization of third- and fourth-generation cephalosporins
Summary
Little is known about risk factors for subsequent infections among vancomycin resistant Enterococcus faecium (VREfm) colonizers, especially characterized by concordant pulsotypes (CP) of paired colonization and infection-related isolates. High proportions of clinical enterococcal isolates possess vancomycin resistance, especially Enterococcus faecium, ranging from 50.0 to 80.0% [2, 3]. In the US, an estimated 20,000 patients were infected by vancomycin-resistant enterococci (VRE), which were associated with more than 1000 deaths annually in 2013 [4]. In the European Union, population-weighted proportions of VRE infections significantly increased 1.4-fold without geographic difference from 2014 to 2017 [5]. The increasing trends of VRE infections have been noted in Asia and Oceania [6,7,8,9].
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