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Colonization and Transmission of High-Level Gentamicin-Resistant Enterococci in a Long-Term Care Facility

Published online by Cambridge University Press:  02 January 2015

Carol E. Chenoweth*
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
Suzanne F. Bradley
Affiliation:
University of Michigan, Medical School and the Veterans Affairs Medical Center, Ann, Arbor, Michigan
Margaret S. Terpenning
Affiliation:
University of Michigan, Medical School and the Veterans Affairs Medical Center, Ann, Arbor, Michigan
Lidija T. Zarins
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
Mary A. Ramsey
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
Dennis R. Schaberg
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
Carol A. Kauffman
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
*
University of Michigan Hospitals, 300 North Ingalls, Room NI2B01, Ann Arbor, MI 48109-0458

Abstract

Objectives:

To assess the prevalence of high-level gentamicin-resistant enterococcus (HGRE) colonization, transmission patterns, and spectrum of illness among residents of a long-term care facility.

Design:

Monthly surveillance for HGRE colonization of wounds, rectum, and perineum over a 1-year period.

Setting:

A Veterans Affairs long-term care facility attached to an acute-care facility.

Patients:

All 341 patients in the facility during the observation period.

Results:

Over the 1-year period, 120 patients (35.2%) were colonized with HGRE at least once, with an overall monthly colonization rate of 20± 1.5%. HGRE were isolated from rectum (12.8%), wounds (11.7%), and perineum (9.3%). Patients with the poorest functional status had the highest rate of colonization (P<0.0005). HGRE-colonized patients were more likely to be colonized with methicillin-resistant Staphylococcus aureus (51% versus 25%; P<0.0005). Seventy-four patients (21.7%) were colonized at admission or at the start of the study. Another 46 patients (13.5%) acquired HGRE during the study, including 36 who acquired HGRE while in the long-term care facility and 10 who were positive when transferred back from the acute-care hospital. Based on plasmid profiles, only two patients appeared to have isolates similar to those of current or previous roommates. Carriage of HGRE was transient in most cases. Only 20 patients were colonized for 4 or more months, and those patients usually carried different strains intermittently. Infections were infrequent, occurring in only 4.1% of total patients.

Conclusions:

In our long-term care facility, HGRE were endemic, and new acquisition of HGRE occurred frequently. However, only two patients had evidence of acquisition from a roommate, suggesting that cross-infection from a roommate was not a major route of spread of HGRE.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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References

1.Schaberg, DR, Culver, DH, Gaynes, RP. Major trends in the microbial etiology of nosocomial infections. Am J Med 1991;91(suppl 3B):72S75S.CrossRefGoogle Scholar
2.Kaye, D. Enterococci: biologic and epidemiologic characteristics and in vitro susceptibility. Arch Intern Med 1982;142:20062009.CrossRefGoogle ScholarPubMed
3.Gross, PA, Harkavy, LM, Barden, GE, Flower, METhe epidemiology of nosocomial enterococcal urinary tract infections. Am J Med Sci 1976;272:7581.CrossRefGoogle Scholar
4.Mandell, GL, Kaye, D, Levinson, ME, Hook, EW. Enterococcal endocarditis: an analysis of 38 patients observed at the New York Hospital-Cornell Medical Center. Arch Intern Med 1970; 125:258264.CrossRefGoogle ScholarPubMed
5.Zervos, MJ, Dembinski, S, Mikesell, TSchaberg, DR. High-level resistance to gentamicin in Streptococcus faecalis: risk factors and evidence of exogenous acquisition of infection. J Infect Dis 1986;153:10751083.CrossRefGoogle Scholar
6.Zervos, MJ, Kauffman, CA, Therasse, PM, Bergman, AG, Mikesell, TS, Schaberg, DS. Nosocomial infection by gentamicin-resistant Streptococcus faecalis: an epidemiologic study. Ann Intern Med 1987:106:687691.CrossRefGoogle Scholar
7.Rhinehart, E, Smith, NE, Wennersten, C, et alRapid dissemination of ß-lactamase-producing aminoglycoside-resistant Enterococcus faecalis among patients and staff on an infant-toddler surgical ward. N Engl J Med 1990;323:18141818.CrossRefGoogle Scholar
8.Livornese, LL, Dias, S, Samel, C, et alHospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112116.CrossRefGoogle ScholarPubMed
9.Horodniceanu, TBougueleret, L, El-Sohl, N, Bieth, G, Delbos, EHigh-level, plasmid-borne resistance to gentamicin in Streptococcus faecalis subspecies zymogenes. Antimicrob Agents Chemother 1979;16:686689.CrossRefGoogle Scholar
10.Mederski-Samoraj, BD. Murray, BE. High-level resistance to gentamicin in clinical isolates of enterococci. J Infect Dis 1983;147:751757.CrossRefGoogle ScholarPubMed
11.Zervos, MJ, T&penning, MS, Schaberg, DR, Therasse, PM, Medendorp, SV, Kauffman, CA. High-level aminoglycoside-resistant enterococci: colonization of nursing home and acute care hospital patients. Arch Intern Med 1987;147:15911594.CrossRefGoogle ScholarPubMed
12.Terpenning, MS, Zervos, MJ, Schaberg, DR. Kauffman, CAEnterococcal infections: an increasing problem in hospitalized patients. Infect Control Hosp Epidemiol 1988;9:457461.CrossRefGoogle ScholarPubMed
13.Bradley, SFTerpenning, MS, Ramsey, MA, et alMethicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417422.CrossRefGoogle Scholar
14.Terpenning, MS, Bradley, SEWan, JY, Chenoweth, CE, Jorgensen, KA, Kauffman, CA. Colonization and infection with antibiotic-resistant bacteria in a long-term care facility. J Am Geriatr Soc. In press.Google Scholar
15.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.CrossRefGoogle ScholarPubMed
16.Zervos, MJ, Patterson, JE, Edberg, S, et alSingle-concentration broth microdilution test for the detection of high-level aminoglycoside resistance in enterococci. J Clin Microbiol 1987;25:24432444.Google ScholarPubMed
17.Ish-Horowitz, D, Burke, JERapid and efficient cosmid cloning. Nucleic Acids Research 1981;9:29892998.CrossRefGoogle Scholar
18.Murray, BE, Singh, KV, Heath, JD, Sharma, BR, Weinstock, GM. Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites.] Clin Microbiol 1990;28:20592063.Google Scholar
19.Murray, BE. The life and times of the enterococcus. Clin Microbiol Rev 1990;3:4665.CrossRefGoogle ScholarPubMed
20.Moellering, RC Jr. Emergence of enterococcus as a significant pathogen. Clin Infect Dis 1992,14:11731178.CrossRefGoogle ScholarPubMed
21.Morrison, AJ, Wenzel, RP. Nosocomial urinary tract infections due to enterococcus: ten years experience at a university hospital. Arch Intern Med 1986;146:15491551.CrossRefGoogle Scholar
22.Maki, DG, Agger, WAEnterococcal bacteremia: clinical features, the risk of endocarditis, and management. Medicine 1988;67:248269.CrossRefGoogle ScholarPubMed
23.Moellering, RC Jr. The enterococcus: a classic example of the impact of antimicrobial resistance on therapeutic options. J Antimicrobial Chemother 1992;28:112.CrossRefGoogle ScholarPubMed
24.Ferreti, JJ, Gilmore, KS, Courvalin, I? Nucleotide sequence analysis of the gene specifying 6’-aminoglycoside acetyltransferase 2”aminoglycoside phosphotransferase enzyme in Streptococcus faecalis and identification and cloning of gene regions specifying the two activities. J Bacteriol 1986;167:631638.CrossRefGoogle Scholar
25.Zervos, MJ, Mikesell, TS, Schaberg, DR. Heterogeneity of plasmids determining high-level resistance to gentamicin in clinical isolates of Streptococcus faecalis. Antimicrob Agents Chemother 1986;30:7881.CrossRefGoogle ScholarPubMed
26.Patterson, JE, Masecar, BL, Kauffman, CA, Schaberg, DR, Hierholzer, WJ, Zervos, MJ. Gentamicin resistance plasmids of entemcocci from diverse geographic areas are heterogeneous. J Infect Dis 1988;158:212216.CrossRefGoogle ScholarPubMed
27.Karanfil, LV, Murphy, M, Josephson, A, et alA cluster of vancomycin-resistant Enterococcus fuecium in an intensive care unit. Infect Control Hosp Epidemiol 1992; 13; 195200.CrossRefGoogle Scholar
28.Ward, TT, Winn, RE, Hartstein, AI, Sewell, DL. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control. Infect Control 1981;2:453459.CrossRefGoogle Scholar
29.Reboli, AC, John, JF Jr, Platt, CG, Cantrey, JR. Methicillin-resistant Staphylococcus aureus outbreak at a Veterans Affairs medical center: importance of carriage of the organism by hospital personnel. Infect Control Hosp Epidemiol 1990;11:291296.CrossRefGoogle Scholar
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