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Determination of Risk Factors Associated With Isolation of Linezolid-Resistant Strains of Vancomycin-Resistant Enterococcus

Published online by Cambridge University Press:  02 January 2015

Jason M. Pogue
Affiliation:
Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
David L. Paterson
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
A. William Pasculle
Affiliation:
Clinical Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Brian A. Potoski*
Affiliation:
Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
*
Division of Infectious Diseases, Suite 3A, Falk Medical Building; 3601 Fifth Avenue, Pittsburgh PA 15213 (potoskiba@upmc.edu)

Abstract

Objective.

To identify independent risk factors associated with isolation of linezolid-resistant, vancomycin-resistant Enterococcus (VRE).

Design.

A retrospective, case-case-control study.

Setting.

A tertiary care, academic medical center.

Methods.

VRE isolates from clinical cultures were retrospectively analyzed for linezolid resistance during our 18-month study period. Clinical data were obtained from electronic patient records, and the risk factors associated with isolation of linezolid-resistant VRE were determined by comparison of 2 case groups with a control group.

Results.

A total of 20% of the VRE isolates analyzed during the study period were linezolid resistant, and resistant isolates were most commonly recovered from the urine (40% of resistant isolates). Risk factors found to be associated with isolation of linezolid-resistant VRE were peripheral vascular disease and/or the receipt of a solid organ transplant, total parenteral nutrition, piperacillin-tazobactam, and/or cefepime. Only 25% of patients from whom linezolid-resistant VRE was isolated had previous linezolid exposure, and in the multivariate model this was not found to be a risk factor associated with the isolation of linezolid-resistant VRE.

Conclusions.

The results of this analysis suggest that there is horizontal transmission of linezolid-resistant VRE in our institution and highlight the need for improved infection control measures. Furthermore, the high incidence of linezolid-resistant VRE demands a reassessment of our empirical antibiotic selection for patients infected with VRE.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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