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Descriptive Epidemiology and Case-Control Study of Patients Colonized With Vancomycin-Resistant Enterococcus and Methicillin-Resistant Staphylococcus aureus

  • Bryndis Sigurdardottir (a1), Jeffery Vande Berg (a2), Jianfang Hu (a1) (a3), Josiah Alamu (a1), Louise-Anne McNutt (a4), Daniel J. Diekema (a1) (a5) (a2) and Loreen A. Herwaldt (a1) (a2) (a6)...

Abstract

Background.

Patients colonized or infected with vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus may be at risk of acquiring vancomycin-resistant S. aureus if the vanA gene is transferred from vancomycin-resistant enterococcus to methicillin-resistant S. aureus..

Objective.

Our goal was to identify risk factors for cocolonization or coinfection (CC/CI) with vancomycin-resistant enterococcus and methicillin-resistant S. aureus.

Design.

We conducted a descriptive, epidemiologic study of all patients with CC/CI identified from January 1998 to May 2003 and a nested case-control study of a cohort of patients hospitalized in the burn and wound unit.

Setting.

We conducted our study in a 813-bed tertiary care university teaching hospital.

Population.

The study population consisted of patients found to have CC/CI during the study period.

Methods.

Descriptive epidemiologic data were collected from hospital records of all patients identified as having CC/CI. A subset of patients hospitalized in the burn and wound unit were included in a case-control study.

Results.

CC/CI was detected in 71% of the patients during a single hospital stay. The burn and wound unit, which does active surveillance for both organisms, and the general medicine unit, which does not do active surveillance for either organism, cared for more than one-half of these patients. Among patients being cared for in the burn and wound unit, having exposure to 2 or more invasive devices (central venous catheters, indwelling urinary catheters, and enteral feeding tubes) and renal insufficiency were independent risk factors for CC/CI.

Conclusions.

Patients with CC/CI are the population at greatest risk for vancomycin-resistant S. aureus colonization or infection. The number of invasive devices to which patients are exposed and, thus, possibly the patients' underlying severity of illness, as well as renal insufficiency, appear to be risk factors for CC/CI.

Copyright

Corresponding author

Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, (loreen-herwaldt@uiowa.edu)

References

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1.Centers for Disease Control and Prevention. National nosocomial infections surveillance (NNIS) system report, data summary from January 1992 to June 2002, issued August 2002. Am J Infect Control 2002; 30: 458475.
2.Noble, WC, Virani, Z, Cree, R. Co-transfer of vancomycin and other resistance genes from EnterococcusfaecalisNCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett 1992; 72:195198.
3.Centers for Disease Control and Prevention. Staphylococcus aureus resistant to vancomycin—United States, 2002. MMWR Morb Mortal Wkly Rep 2002; 51:565567.
4.Centers for Disease Control and Prevention. Vancomycin-resistant Staphylococcus aureus—Pennsylvania, 2002. MMWR Morb Mortal Wkly Rep 2002; 51:902.
5.Centers for Disease Control and Prevention. Vancomycin-resistant Staphylococcus aureus—New York, 2004. MMWR Morb Mortal Wkly Rep 2004; 53:322323.
6.Tenover, FC, McDonald, LC. Vancomycin-resistant staphylococci and enterococci: epidemiology and control. Curr Opin Infect Dis 2005; 18: 300305.
7.Chang, S, Sievert, DM, Hageman, JC, et al. Brief report: infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N Engl J Med 2003; 348:13421347.
8.Weigel, LM, Clewell, DB, Gill, SR, et al. Genetic analysis of a high-level vancomycin-resistant isolate of Staphylococcus aureus. Science 2003; 302: 15691571.
9.Karchmer, T, Cook, E, Kilgo, P, et al. Point prevalence of methicillin- resistant Staphylococcus aureus and vancomycin-resistant enterococci in a tertiary care hospital. In: Program and abstracts of the 4th Annual Meeting of the Infectious Diseases Society of America, 2002, Chicago. Abstract 402.
10.Trick, WE, Weinstein, RA, DeMarais, PL, et al. Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. J Am Geriatr Soc 2001; 49:270276.
11.Ray, AJ, Pultz, NJ, Bhalla, A, et al. Coexistence of vancomycin-resistant enterococci and Staphylococcus aureus in the intestinal tracts of hospitalized patients. Clin Infect Dis 2003; 37:875881.
12.Franchi, D, Climo, MW, Wong, AHM, Edmond, MB, Wenzel, RP. Seeking vancomycin-resistant Staphylococcus aureus among patients with vancomycin-resistant enterococci. Clin Infect Dis 1999; 29:15561558.
13.Charlson, ME, Pompei, PP, Ales, KK, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373383.
14.Pfaller, MA, Wendt, C, Hollis, RJ, et al. Comparative evaluation of an automated ribotyping system versus pulsed-field gel electrophoresis for epidemiological typing of clinical isolates of Escherichia coli and Pseudomonas aeruginosa from patients with recurrent gram-negative bacteremia. Diagn Microbiol Infect Dis 1996; 25:18.
15.Hospital Infection Control Practices Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995; 16:105113.
16.Price, CS, Paule, S, Noskin, GA, Peterson, LR. Active surveillance reduces the incidence of vancomycin-resistant enterococcal bacteremia. Clin Infect Dis 2003; 37:921928.
17.Siddiqui, AH, Harris, AD, Hebden, J, Wilson, PD, Morris, JG, Roghmann, M. The effect of active surveillance for vancomycin-resistant enterococci in high risk units on vancomycin-resistant enterococci incidence hospital-wide. Am J Infect Control 2002; 30:4043.
18.Warren, DK, Nitin, A, Hill, C, Fraser, VJ, Kollef, MH. Occurrence of co-colonization or co-infection with vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2004; 25:99104.
19.Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982; 97:309317.
20.Lucas, GM, Lechtzin, N, Puryear, DW, Yau, LL, Flexner, CW, Moore, RD. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis 1998; 26:11271133.
21.Linden, PK, Pasculle, AW, Manez, R, et al. Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcusfaecium or vancomycin-susceptible E. faecium. Clin Infect Dis 1996; 22:663670.
22.Byers, KE, Anglim, AM, Anneski, CJ, Farr, BM. A hospital epidemic of vancomycin-resistant enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001; 22:140147.
23.Ostrowsky, BE, Trick, WE, Sohn, AH, et al. Control of vancomycin-resistant Enterococcus in health care facilities in a region. New Engl J Med 2001; 344:14271433.
24.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003; 24:362386.
25.Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guideline for preventing health-care associated pneumonia, 2003. Available at: http://www.cdc.gov/ncidod/hip/guide/CDCpneumo_guidelines.pdf. Accessed May 26, 2005.
26.O'Grady, NP, Alexander, M, Dellinger, EP, et al. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002; 51(RR-10):129.
27.Boyce, JM, Pittet, D. Guideline for hand hygiene in health care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep 2002; 51(RR-16):145.

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