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Factors Associated With Acquisition of Vancomycin-Resistant Enterococci (VRE) in Roommate Contacts of Patients Colonized or Infected with VRE in a Tertiary Care Hospital

Published online by Cambridge University Press:  02 January 2015

Qian Zhou ,
Christine Moore ,
Sarah Eden ,
Agnes Tong ,
Allison McGeer  and
Mount Sinai Hospital Infection Control Team
Qian Zhou
Affiliation:
Department of Public Health Sciences, University of Toronto, Canada
Christine Moore
Affiliation:
Mount Sinai Hospital, Toronto, Ontario, Canada
Sarah Eden
Affiliation:
Mount Sinai Hospital, Toronto, Ontario, Canada
Agnes Tong
Affiliation:
Mount Sinai Hospital, Toronto, Ontario, Canada
Allison McGeer*
Affiliation:
Department of Public Health Sciences, University of Toronto, Canada Mount Sinai Hospital, Toronto, Ontario, Canada
*
Room 210, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, (amcgeer@ mtsinai.on.ca)
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Abstract

Objective.

Most nosocomial acquistion of vancomycin-resistant enterococci (VRE) is due to cross-transmission. We sought to identify risk factors for acquisition of VRE by roommates of patients colonized or infected with VRE.

Design.

Retrospective cohort study.

Setting.

A 472-bed tertiary care teaching hospital.

Methods.

All patients who shared a room with a patient colonized or infected with VRE at our hospital between January 1, 1999 and December 31, 2006 were identified. These roommates of VRE-positive patients were screened by rectal swab culture on days 2, 5, and 7 after the last exposure to the index patient. Chart reviews were performed to identify risk factors for VRE colonization in these roommates.

Results.

Eighty-eight roommates of patients colonized or infected with VRE were identified. Of the 38 roommates with complete follow-up, 8 (21%) became colonized with VRE. These 8 roommates were older (median, 87.5 vs 62.5 years of age; P = .001), had longer duration of room exposure (median, 8.5 vs 4 days; P = .002), and were more likely to have a urinary catheter (odds ratio [OR], 16 [95% confidence interval {CI}, 1.7-152]; P = .005), an elevated serum creatinine level (OR, 17 [95% CI, 1.4-196]; P = .02), low serum albumin level (OR, 9.9 [95% CI, 1.3-113]; P = .01), and recent third-generation cephalosporin use (OR, 8.3 [95% CI, 1.5-47]; P = .02).

Conclusion.

Roommates of patients identified as colonized or infected with VRE are at substantial risk of becoming colonized, with the degree of risk increasing in older and more frail patients. VRE control programs should pay particular attention to such patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 5 , May 2008 , pp. 398 - 403
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.McGeer, A, Fleming, CA, Willey, B, Green, KA, Low, DE. Antimicrobial resistance in common hospital pathogens in Ontario. Ontario Medical Association, QMP-LS News 2007; No. 116. Available at: http://www.qmpls.org/pub_resources/publications/qmpls_news/pdf/qmplsnewsll6.pdf. Accessed October 20, 2007.Google Scholar
2.Noble, WC, Virani, Z, Cree, RGA. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett 1992;72:195–198.CrossRefGoogle ScholarPubMed
3.Appelbaum, PC. The emergence of vancomycin-intermediate and van-comycin-resistant Staphylococcus aureus. Clin Microbiol Infect 2006;12(suppl 1):16–23.Google Scholar
4.Zirakzadeh, A, Patel, R. Vancomycin-resistant enterococci: colonization, infection, detection, and treatment. Mayo Clin Proc 2006;81:529–36.Google Scholar
5.Byers, KE, Anglim, AM, Anneski, CJ, et al.A hospital epidemic of vancomycin-resistant enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001;22:140–147.Google Scholar
6.Bonten, MJ, Slaughter, S, Ambergen, AW, et 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
7.Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1995;44:1–13.Google Scholar
8.Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.Google Scholar
9.Antimicrobial resistance at the Mount Sinai Hospital. March 2007. Available at: http://microbiology.mtsinai.on.ca/ic/report/2007report.pdf. Accessed February 28, 2008.Google Scholar
10.Willey, BM, Jones, RN, McGeer, A, et al.Practical approach to the identification of clinically relevant Enterococcus species. Diagn Microbiol Infect Dis 1999;34:165–171.CrossRefGoogle Scholar
11.NCCLS. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically: 5th ed. Approved standard M7-A5. Wayne, PA: NCCLS, 2000.Google Scholar
12.Ulrich, RS, Quan, X, Choudhary, R, Joseph, A, Zimring, C. Evidence-Based Design Research for Healthcare. 2004. Available at: http://www.health-design.org/research/reports/physical_environ.php. Accessed October 20, 2007.Google Scholar
13.Kibbler, CC, Quick, A, O'Neill, AM. The effect of increased bed numbers on MRSA transmission in acute medical wards. J Hosp Infect 1998;39:213–219.Google Scholar
14.Gastmeier, P, Schwab, F, Geifers, C, Ruden, H. To isolate or not to isolate? Analysis of data from the German Nosocomial Infection Surveillance System regarding the placement of patients with methicillin-resistant Staphylococcus aureus in private rooms in intensive care units. Infect Control Hosp Epidemiol 2004;25:109–113.Google Scholar
15.Mulin, B, Rouget, C, Clement, C, et al.Association of private isolation rooms with ventilator-associated Acinetobacter baumanii pneumonia in a surgical intensive-care unit. Infect Control Hosp Epidemiol 1997;18:499–503.Google Scholar
16.Bhavnani, SM, Drake, JA, Forrest, A, et al.A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis 2000;36:145–158.Google Scholar
17.Timmers, GJ, van der Zwet, WC, Simoons-Smit, IM, et al.Outbreak of vancomycin-resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic. Br J Haematol 2002;116:826–833.CrossRefGoogle Scholar
18.Tacconelli, E, Karchmer, AW, Yokoe, D, et al.Preventing the influx of vancomycin-resistant enterococci into health care institutions, by use of a simple validated prediction rule. Clin Infect Dis 2004;39:964–970.CrossRefGoogle ScholarPubMed
19.Wendt, C, Krause, C, Xander, LU, et al.Prevalence of colonization with vancomycin-resistant enterococci in various population groups in Berlin, Germany. J Hosp Infect 1999;42:193–200.Google Scholar
20.Carmeli, Y, Eliopoulos, GM, Samore, MH. Antecedent treatment with different antibiotic agents as a risk factor for vancomycin-resistant Enterococcus. Emerg Infect Dis 2002;8:802–807.Google Scholar
21.D'Agata, EM, Gautam, S, Green, WK, et al.High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis 2002;34:167–172.Google Scholar