The Cephalosporin Use in the Penicillin Allergic Patient

Abstract

groups of patients in a 1:1:1 ratio: the first, with isolation of vancomycin-sensitive E faecalis (VSEF) from a wound; and the second, uninfected controls. A case-case-control analysis was conducted. Results: One hundred-sixteen VREF cases were identified and matched to 116 VSEF cases and to 116 uninfected controls. The mean age of the study cohort was 60.7+-17.1 years, 167 (48%) were males, 266 (76.4%) were African American. Seventy-four (62.2%) cases with VREF and 58 (50%) VSEF patients had hospitalacquired pathogens, (isolated from a culture > 2 days after hospital admission). Eighty-four subjects (24.1%) resided in institutions (nursing home or hospitals) prior to admission (46 [40%] of VREF, 25 [21.6%] of VSEF, 13 [11.2%] of controls; p<0.001 for VREF vs. uninfected controls; p1⁄40.044 for VSEF vs. controls). One hundred seventy-two (49.4%) subjects had dependent functional status on admission (74 [64.9%] of VREF cases, 50 [43.1%] of VSEF cases, 48 [41.4%] of uninfected controls; p1⁄40.001 for VREF vs. uninfected controls). The Charlson's combined comorbidity score (median, [IQR]) were 6.0 (3.2-8.6), 5.5 (2.8-7.6), and 4.8 (1.87.8) for VREF, VSEF, and controls respectively (p1⁄40.03 for VREF compared to uninfected controls). Independent risk factors for the isolation of VREF and VSEF were determined by multivariate analysis (Table). Conclusions: The presence on admission of permanent indwelling devices (e.g. central lines, urinary catheters, hemodialysis catheters, tracheotomies, percutaneous endoscopic gastrostomy [PEG] tubes) and past exposure to Beta-lactam antibiotics were uniquely associated with isolation of VREF but not VSEF. Chronic skin ulcers were associated with the isolation of both VREF and VSEF. The results of this study are in accordance of reported risk factors for VRE and MRSA cocolonization in SEMI, and might explain in part the endemicity of VRSA in this region. Surveillance, proactive infection control measures and antimicrobial stewardship are key methods to control the spread of VREF and continued emergence of VRSA.