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A retrospective cohort study of antibiotic exposure and vancomycin-resistant Enterococcus recolonization

Published online by Cambridge University Press:  07 February 2019

Heather Y. Hughes Open the ORCID record for Heather Y. Hughes [Opens in a new window] ,
Robin T. Odom ,
Angela V. Michelin ,
Evan S. Snitkin ,
Ninet Sinaii ,
Aaron M. Milstone ,
David K. Henderson  and
Tara N. Palmore
Heather Y. Hughes
Affiliation:
The Ralph H. Johnson VAMC, Charleston, South Carolina The Medical University of South Carolina, Charleston, South Carolina
Robin T. Odom
Affiliation:
National Institutes of Health, Bethesda, Maryland
Angela V. Michelin
Affiliation:
National Institutes of Health, Bethesda, Maryland
Evan S. Snitkin
Affiliation:
University of Michigan Medical School, Ann Arbor, Michigan
Ninet Sinaii
Affiliation:
National Institutes of Health, Bethesda, Maryland
Aaron M. Milstone
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
David K. Henderson
Affiliation:
National Institutes of Health, Bethesda, Maryland
Tara N. Palmore*
Affiliation:
National Institutes of Health, Bethesda, Maryland
*
Author for correspondence: Tara N. Palmore, Email: [email protected]
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Abstract

Objective:

In the National Institutes of Health (NIH) Clinical Center, patients colonized or infected with vancomycin-resistant Enterococcus (VRE) are placed in contact isolation until they are deemed “decolonized,” defined as having 3 consecutive perirectal swabs negative for VRE. Some decolonized patients later develop recurrent growth of VRE from surveillance or clinical cultures (ie, “recolonized”), although that finding may represent recrudescence or new acquisition of VRE. We describe the dynamics of VRE colonization and infection and their relationship to receipt of antibiotics.

Methods:

In this retrospective cohort study of patients at the National Institutes of Health Clinical Center, baseline characteristics were collected via chart review. Antibiotic exposure and hospital days were calculated as proportions of VRE decolonized days. Using survival analysis, we assessed the relationship between antibiotic exposure and time to VRE recolonization in a subcohort analysis of 72 decolonized patients.

Results:

In total, 350 patients were either colonized or infected with VRE. Among polymerase chain reaction (PCR)-positive, culture (Cx)-negative (PCR+/Cx−) patients, PCR had a 39% positive predictive value for colonization. Colonization with VRE was significantly associated with VRE infection. Among 72 patients who met decolonization criteria, 21 (29%) subsequently became recolonized. VRE recolonization was 4.3 (P = .001) and 2.0 (P = .22) times higher in patients with proportions of antibiotic days and antianaerobic antibiotic days above the median, respectively.

Conclusion:

Colonization is associated with clinical VRE infection and increased mortality. Despite negative perirectal cultures, re-exposure to antibiotics increases the risk of VRE recolonization.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 4 , April 2019 , pp. 414 - 419
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: Part of these data were presented as an abstract at ID Week 2014 on October 9, 2014, in Philadelphia, Pennsylvania, and as a poster presentation at ID Week 2015 on October 9, 2015, in San Diego, California.

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