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Risk of Vancomycin-Resistant Enterococcus (VRE) Bloodstream Infection Among Patients Colonized With VRE

Published online by Cambridge University Press:  02 January 2015

Chamion N. Olivier ,
Ruth K. Blake ,
Lisa L. Steed  and
Cassandra D. Salgado
Chamion N. Olivier
Affiliation:
Medical University of South Carolina, Charleston, South Carolina
Ruth K. Blake
Affiliation:
Medical University of South Carolina, Charleston, South Carolina
Lisa L. Steed
Affiliation:
Medical University of South Carolina, Charleston, South Carolina
Cassandra D. Salgado*
Affiliation:
Medical University of South Carolina, Charleston, South Carolina
*
Medical University of South Carolina, 100 Doughty Street, Suite 210 IOP S, Charleston, SC 29425, ([email protected])
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Abstract

Background.

Colonization with vancomycin-resistant Enterococcus (VRE) is a risk factor for subsequent VRE bloodstream infection (BSI); however, risk factors for BSI among colonized patients have not been adequately described. We sought to determine the proportion of VRE-colonized patients who subsequently develop VRE BSI and to identify risk factors for VRE BSI among these patients.

Methods.

Records of 768 patients colonized with VRE from January 2002 through June 2005 were reviewed. The proportion of patients who developed VRE BSI was calculated, and the characteristics of these patients were compared, in a 2 : 1 ratio, with those of patients who did not develop VRE BSI. To identify risk factors for VRE BSI and for death, we used univariate logistic regression analysis and then multivariate logistic regression analysis. Using pulsed-field gel electrophoresis (PFGE), we compared the isolate recovered when the patient was colonized and the isolate recovered when the patient developed VRE BSI.

Results.

Of the 768 patients colonized with VRE, 31 (4.0%) developed VRE BSI. Multivariate analysis identified the following idependent risk factors for developing VRE BSI: infection of an additional body site other than blood (adjusted odds ratio [aOR], 3.9; P = .04), admission to the hospital from a long-term care facility (aOR, 12.6; P = .04), and receipt of vancomycin (aOR, 10.6; P < .001). The independent risk factors for death among patients colonized with VRE were immunosuppression (aOR, 12.9; P = .001 ) and VRE BSI (aOR, 9.1; P = .002). Of the 31 patients who developed VRE BSI, 23 (74%) had a pair of isolates representing VRE colonization and VRE BSI. For 19 (83%) of these 23 patients, the isolate representing BSI was genetically related to the isolate representing VRE colonization: 12 pairs of isolates (52%) had identical banding patterns, 5 had closely related patterns, and 2 had possibly related patterns.

Conclusion.

Of the 768 patients colonized with VRE, 31 (4.0%) usually developed VRE BSI due to a related strain. Independent risk factors for BSI among colonized patients were admission from a long-term care facility, infection of an additional body site, and exposure to vancomycin. Independent risk factors for death were immunosuppression and VRE BSI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 5 , May 2008 , pp. 404 - 409
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Bhorade, SM, Christensen, J, Pohlman, AS, Arnow, PM, Hall, JB. The incidence of and clinical variables associated with vancomycin-resistant enterococcal colonization in mechanically ventilated patients. Chest 1999;115:1085–1091.Google Scholar
2.Linden, PKet al.Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-sus-ceptible E. faecium. Clin Infect Dis 1996;22:663–670.Google Scholar
3.Stosor, Vet al.Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med 1998;158:522–527.Google Scholar
4.Edmond, MBet al.Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin Infect Dis 1996;23:1234–1239.CrossRefGoogle ScholarPubMed
5.Carmeli, Yet al.Health and economic outcomes of vancomycin-resistant enterococci. Arch Intern Med 2002;162:2223–2228.Google Scholar
6.Lucas, GMet al.Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis 1998;26:1127–1133.Google Scholar
7.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
8.Saigado, CD, Farr, BM. Outcomes associated with vancomycin-resistant enterococci: a meta-analysis. Infect Control Hosp Epidemiol 2003;24:690–698.Google Scholar
9.CA, DiazGranadoset al.Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 2005;41:327–333.Google Scholar
10.Peset, Vet al.Epidemiological, microbiological, clinical, and prognostic factors of bacteremia caused by high-level vancomycin-resistant Enterococcus species. Eur J Clin Microbiol Infect Dis 2000;19:742–749.CrossRefGoogle ScholarPubMed
11.Garbutt, JMet al.Association between resistance to vancomycin and death in cases of Enterococcus faecium bacteremia. Clin Infect Dis 2000;30:466–472.Google Scholar
12.Vergis, ENet al.Determinants of vancomycin resistance and mortality rates in enterococcal bacteremia, a prospective multicenter study. Ann Intern Med 2001;135:484–492.Google Scholar
13.Tornieporth, NGet al.Risk factors associated with vancomycin-resistant Enterococcus faecium infection or colonization in 145 matched case patients and control patients. Clin Infect Dis 1996;23:767–772.Google Scholar
14.Lautenbach, E, Bilker, WB, Brennan, PJ. Enterococcal bacteremia: risk factors for vancomycin resistance and predictors of mortality. Infect Control Hosp Epidemiol 1999;20:318–323.CrossRefGoogle ScholarPubMed
15.Bonten, MJet al.The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:1127–1132.Google Scholar
16.Lucus, 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;26:1127–1133.Google Scholar
17.Zaas, AKet al.Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci. Clin Infect Dis 2002;35:1139–1146.Google Scholar
18.Shay, DKet al.Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect 1995;172:993–1000.CrossRefGoogle ScholarPubMed
19.Furtado, GHet al.Risk factors for vancomycin-resistant Enterococcus faecalis bacteremia in hospitalized patients: an analysis of two case-control studies. Am J Infect Control 2006;34:447–451.Google Scholar
20.Montecalvo, MAet al.Outbreak of vancomycin-, ampicillin-, and ami-noglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.Google Scholar
21.Roghmann, MCet al.Clostridium difficile infection is a risk factor for bacteremia due to vancomycin-resistant enterococci (VRE) in VRE-col-onized patients with acute leukemia. Clin Infect Dis 1997;25:1056–1059.CrossRefGoogle ScholarPubMed
22.Matar, MJ, Tarrand, J, Raad, I, Rolston, KVI. Colonization and infection with vancomycin-resistant Enterococcus among patients with cancer. Am J Infect Control 2006;34:534–536.Google Scholar
23.Kapur, Det al.Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2000;25:147–152.Google Scholar
24.Tenover, FCet al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
25.Weinstock, DMet al.Colonization, bloodstream infection, and mortality caused by vancomycin-resistant Enterococcus early after allogeneic hematopoietic stem cell transplant. Biol Blood Marrow Transplant 2007;13:615–621.Google Scholar
26.Patel, Ret al.Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients. Liver Transpl 2001;7:27–31.Google Scholar
27.Brennen, C, Wagener, MM, Muder, RR. Vancomycin-resistant Enterococcus faecium in a long-term care facility, J Am Geriatr Soc 1998;46:157–160.CrossRefGoogle ScholarPubMed
28.Bakir, M, Bova, JL, Newell, KA, Micael, MI, Buell, JF, Arnow, PM. Epidemiology and clinical consequences of vancomycin-resistant enterococci in liver transplant patients. Transplantation 2001;72:1032–1037.CrossRefGoogle ScholarPubMed
29.McNeil, SA, Malani, PN, Chenoweth, CE, et al.Vancomycin-resistant enterococcal colonization and infection in liver transplant candidates and recipients: a prospective surveillance study. Clin Infect Dis 2006;42:195–203.CrossRefGoogle ScholarPubMed
30.Mainous, MR, Lipsett, PA, O'Brien, M. Enterococcal bacteremia in the surgical intensive care unit. Does vancomycin resistance affect mortality? The Johns Hopkins SICU Study Group. Arch Surg 1997;132:76–81.CrossRefGoogle Scholar
31.Carmeli, Y, Samore, MH, Huskins, C. The association between antecedent vancomycin treatment and hospital-acquired vancomycin-resistant enterococci: a meta-analysis. Arch Intern Med 1999;159:2461–2468.CrossRefGoogle ScholarPubMed
32.Huh, JY, Lee, WG, Jin, HY. Molecular characterization of vancomycin-resistant enterococci from clinical and surveillance specimens. Infect Control Hosp Epidemiol 2006;27:1076–1080.CrossRefGoogle ScholarPubMed
33.Henning, KJet al.Vancomycin-resistant Enterococcus faecium on a pediatric oncology ward: duration of stool shedding and incidence of clinical infection. Pediatr Infect Dis J 1996;15:848–854.Google Scholar
34.LeDell, Ket al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:639–641.Google Scholar
35.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, and the Healthcare Infection Control Practices Advisory Committee, Management of Multi-drug-Resistant Organisms in Healthcare Settings. 2006. Center for Disease Control and Prevention. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed October 31, 2007.Google Scholar