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Occurrence of Co-colonization or Co-Infection with Vancomycin-Resistant Enterococci and Methicillin-Resistant Staphylococcus aureus in a Medical Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

David K. Warren ,
Anand Nitin ,
Cheri Hill ,
Victoria J. Fraser  and
Marin H. Kollef
David K. Warren
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Anand Nitin
Affiliation:
Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, Missouri
Cheri Hill
Affiliation:
Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Marin H. Kollef*
Affiliation:
Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, Missouri
*
Washington University School of Medicine, Box 8052, 660 South Euclid Avenue, St. Louis, MO 63110
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Abstract

Objective:

To determine the occurrence of co-colonization or co-infection with VRE and MRSA among medical patients requiring intensive care.

Design:

Prospective, single-center, observational study.

Setting:

A 19-bed medical ICU in an urban teaching hospital.

Patients:

Adult patients requiring at least 48 hours of intensive care and having at least one culture performed for microbiologie evaluation.

Results:

Eight hundred seventy-eight consecutive patients were evaluated. Of these patients, 402 (45.8%) did not have microbiologie evidence of colonization or infection with either VRE or MRSA 355 (40.4%) were colonized or infected with VRE, 38 (4.3%) were colonized or infected with MRSA, and 83 (9.5%) had co-colonization or co-infection with VRE and MRSA. Multiple logistic regression analysis demonstrated that increasing age, hospitalization during the preceding 6 months, and admission to a long-term-care facility were independently associated with colonization or infection due to VRE and co-colonization or co-infection with VRE and MRSA. The distributions of positive culture sites for VRE (stool, 86.7%; blood, 6.5%; urine, 4.8%; soft tissue or wound, 2.0%) and for MRSA (respiratory secretions, 34.1%; blood, 32.6%; urine, 17.1%; soft tissue or wound, 16.2%) were statistically different (P < .001).

Conclusions:

Co-colonization or co-infection with VRE and MRSA is common among medical patients requiring intensive care. The recent emergence of vancomycin-resistant Staphylococcus aureus and the presence of a patient population co-colonized or co-infected with VRE and MRSA support the need for aggressive infection control measures in the ICU.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 2 , February 2004 , pp. 99 - 104
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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