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A Case-Control Study of Nosocomial Ampicillin-Resistant Enterococcal Infection and Colonization at a University Hospital

Published online by Cambridge University Press:  21 June 2016

Daniel J. Sexton ,
Lizzie J. Harrell ,
Jackie J. Thorpe ,
Debra L. Hunt  and
L. Barth Reller
Daniel J. Sexton*
Affiliation:
Depatiments of Medicine, Duke University, Medical Center, Durham, North Carolina Infection Control Unit, Duke University, Medical Center, Durham, North Carolina
Lizzie J. Harrell
Affiliation:
Microbiology, Duke University, Medical Center, Durham, North Carolina Clinical Microbiology Laboratory, Duke University, Medical Center, Durham, North Carolina
Jackie J. Thorpe
Affiliation:
Clinical Microbiology Laboratory, Duke University, Medical Center, Durham, North Carolina
Debra L. Hunt
Affiliation:
Infection Control Unit, Duke University, Medical Center, Durham, North Carolina
L. Barth Reller
Affiliation:
Depatiments of Medicine, Duke University, Medical Center, Durham, North Carolina Pathology, Duke University, Medical Center, Durham, North Carolina Clinical Microbiology Laboratory, Duke University, Medical Center, Durham, North Carolina
*
Box 3605, Duke University Medical Center, Durham NC 27710
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Abstract

Objective:

To assess risk factors for colonization and nosocomial infection with ampicillin-resistant enterococci (ARE).

Design:

Patients with ampicillin-resistant enterococci were compared retrospectively by logistic regression analysis with controls harboring susceptible strains. ARE were characterized by whole plasmid DNA analysis and restriction enzyme analysis of plasmid (REAP) DNA with EcoRI.

Setting:

The study was done at a 1,125 bed, tertiary-care teaching hospital in North Carolina with patients from whom enterococci were isolated from June 1, 1989, to March 30, 1991.

Patients:

The final study group comprised 44 cases with nosocomially-acquired colonization or infection with ARE and 100 controls with ampicillin-susceptible strains. Clinical and epidemiological risk factors for ARE were abstracted by chart review.

Results:

After controlling for age and site of infection, patients with ARE were more likely to have been admitted previously to our hospital and to have received third-generation cepha-losporins and clindamycin. However, only advanced age and clindamycin therapy were independently associatedwith presence of ARE. REAP with EcoRI showed 20 groups of enterococci on 19 different wards.

Conclusions:

These results suggest that ARE are endemic and multifocal in origin in our hospital and that advanced age and use of clindamycin are important selective risk factors for ARE colonization and infection (Infect Control Hosp Epidemiol1993;14:629-635).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 11 , November 1993 , pp. 629 - 635
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993 

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