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Recovery of Both Vancomycin-Resistant Enterococci and Methicillin-Resistant Staphylococcus aureus From Culture of a Single Clinical Specimen From Colonized or Infected Patients

Published online by Cambridge University Press:  02 January 2015

Sang Hoon Han
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Bum Sik Chin
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Han Sung Lee
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Su Jin Jeong
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Hee Kyung Choi
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Chang Ki Kim
Affiliation:
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
Chang Oh Kim
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Dongeun Yong
Affiliation:
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
Jun Yong Choi
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Young Goo Song
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Kyungwon Lee
Affiliation:
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
June Myung Kim
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Corresponding
E-mail address:

Abstract

Objective.

To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.

Design.

A retrospective cohort and case-control study.

Setting.

A tertiary care university hospital and referral center in Seoul, Korea.

Methods.

We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.

Results.

The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00; P = .012), urinary catheterization (OR, 3.36; P = .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03; P < .001).

Conclusion.

We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer of vanA, close observation and surveillance for vancomycin-resistant S. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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Recovery of Both Vancomycin-Resistant Enterococci and Methicillin-Resistant Staphylococcus aureus From Culture of a Single Clinical Specimen From Colonized or Infected Patients
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