Similarities and Differences in Risk Factors for Vancomycin-resistant Enterococcus Colonization between an Acute Hospital and its affiliated Intermediate- and Long-term care facilities

Abstract

Background: Vancomycin-resistant Enterococci (VRE) infections in acute hospitals (AHs) are increasing, but little is known in intermediate- and long-term care facilities (ILTCs). Patients often transfer between AHs and ILTCs. We sought to compare risk factors for VRE colonization between an AH and ILTCs in a healthcare network. Methods & Materials: Two cross-sectional studies were conducted in a 1600-bed tertiary-care AH and its six affiliated ILTCs in June-July 2014 and June-July 2015. Rectal swabs or stool were cultured for VRE. Clinical data were obtained from medical records and associations with colonization made. To control for confounding, multivariable logistic regression models were constructed. Results: Of 3469 patients screened, 11.4% were colonized with VRE. VRE prevalence was higher in the AH(16.9%) than ILTCs(4.4%)(OR 2.75, 95%CI 1.96-3.86, P < 0.001). After adjusting for age, gender, screening year, and co-morbidities, risk factors for VRE colonization in the AH included length of stay(LOS) >14 days(OR 1.67, 95%CI 1.27-2.21, P < 0.001), number of beds in hospital room(OR 1.08 95%CI 1.02-1.15, P = 0.009), presence of wounds(OR 1.82 95%CI 1.39-2.39, P < 0.001), as well as prior admission to the AH(OR 1.42, 95%CI 1.07-1.88, P = 0.014), prior VRE carriage(OR 4.92 95%CI 2.74-8.83, P < 0.001), and prior antibiotics exposure in the preceding 12 months(OR 4.51, 95%CI 2.15-9.44, P < 0.001). For ILTCs, prior admission to AHs(OR 6.73, 95%CI 1.58-28.71, P = 0.010) and prior antibiotics exposure(OR 5.53, 95%CI 1.66-18.40, P = 0.005), presence of indwelling urinary catheter(OR 1.97, 95%CI 1.14-3.40, P = 0.014), and LOS >14 days(OR 0.47, 95%CI 0.26-0.83, P = 0.010) were associated with VRE colonization. Conclusion: Antibiotics exposure and hospitalization in an AH in the preceding 12 months were common risk factors for VRE colonization in the AH and ILTCs. Prior VRE carriage and LOS >14 days increased the risk of colonization in the AH. Presence of indwelling urinary catheter increased but LOS >14 days decreased the risk in ILTCs. Pre-emptive contact precautions and targeted screening could be implemented for these high-risk patients at AHs and ILTCs.