Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-25T18:22:42.808Z Has data issue: false hasContentIssue false
  • English
  • Français

Recovery of Both Vancomycin-Resistant Enterococci and Methicillin-Resistant Staphylococcus aureus From Culture of a Single Clinical Specimen From Colonized or Infected Patients

Published online by Cambridge University Press:  02 January 2015

Sang Hoon Han ,
Bum Sik Chin ,
Han Sung Lee ,
Su Jin Jeong ,
Hee Kyung Choi ,
Chang Ki Kim ,
Chang Oh Kim ,
Dongeun Yong ,
Jun Yong Choi  and
Young Goo Song
...Show all authors
Sang Hoon Han
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Bum Sik Chin
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Han Sung Lee
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Su Jin Jeong
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Hee Kyung Choi
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Chang Ki Kim
Affiliation:
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
Chang Oh Kim
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Dongeun Yong
Affiliation:
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
Jun Yong Choi*
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Young Goo Song
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
Kyungwon Lee
Affiliation:
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
June Myung Kim
Affiliation:
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
*
Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchondong, Seodaemun-gu, Seoul 120-752, Korea ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.

Design.

A retrospective cohort and case-control study.

Setting.

A tertiary care university hospital and referral center in Seoul, Korea.

Methods.

We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.

Results.

The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00; P = .012), urinary catheterization (OR, 3.36; P = .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03; P < .001).

Conclusion.

We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer of vanA, close observation and surveillance for vancomycin-resistant S. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 2 , February 2009 , pp. 130 - 138
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.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
2.European Antimicrobial Resistance Surveillance System (EARSS) Management Team, members of the Advisory Board, and national representatives of EARSS. EARSS Annual Report 2006. Bilthoven, Netherlands: National Institute of Public Health and the Environment; 2007. Available at: http://www.rivm.nl/earss/Images/EARSS%202006%20Def_tcm61-44176.pdf. Accessed August 30, 2008.Google Scholar
3.Kreman, T, Hu, J, Pottinger, J, et al.Survey of long-term care facilities in Iowa for policies and practices regarding residents with methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2005;26:811–815.Google Scholar
4.Sader, HS, Streit, JM, Fritsche, TR, et al.Antimicrobial susceptibility of gram-positive bacteria isolated from European medical centres: results of the Daptomycin Surveillance Programme (2002–2004). Clin Microbiol Infect 2006;12:844–852.CrossRefGoogle ScholarPubMed
5.Streit, JM, Jones, RN, Sader, HS, et al.Assessment of pathogen occurrences and resistance profiles among infected patients in the intensive care unit: report from the SENTRY Antimicrobial Surveillance Program (North America, 2001). Int J Antimicrob Agents 2004;24:111–118.CrossRefGoogle ScholarPubMed
6.Hsueh, PR, Chen, WH, Teng, LJ, et al.Nosocomial infections due to methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci at a university hospital in Taiwan from 1991 to 2003: resistance trends, antibiotic usage and in vitro activities of newer antimicrobial agents. Int J Antimicrob Agents 2005;26:43–49.CrossRefGoogle Scholar
7.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
8.Cosgrove, SE, Sakoulas, G, Perencevich, EN, et al.Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.CrossRefGoogle ScholarPubMed
9.DiazGranados, CA, Zimmer, SM, Klein, M, et al.Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible en-terococcal bloodstream infections: a meta-analysis. Clin Infect Dis 2005;41:327–333.Google Scholar
10.Appelbaum, PC. The emergence of vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus. Clin Microbiol Infect 2006;12(Suppl 1):16–23.Google Scholar
11.Chang, S, Sievert, DM, Hageman, JC, et al.Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N Engl J Med 2003;348:1342–1347.CrossRefGoogle ScholarPubMed
12.Sievert, DM, Rudrik, JT, Patel, JB, McDonald, LC, Wilkins, MJ, Hageman, JC. Vancomycin-resistant Staphylococcus aureus in the United States, 2002–2006. Clin Infect Dis 2008;46:668–674.CrossRefGoogle ScholarPubMed
13.Francia, MV, Clewell, DB. Transfer origins in the conjugative Enterococcus faecalis plasmids pADl and pAM373: identification of the pADl nie site, a specific relaxase and a possible TraG-like protein. Mol Microbiol 2002;45:375–395.Google Scholar
14.Noble, WC, Rahman, M, Karadec, T, et al.Gentamicin resistance gene transfer from Enterococcus faecalis and E. faecium to Staphylococcus aureus, S. intermedius and S. hyicus. Vet Microbiol 1996;52:143–152.CrossRefGoogle Scholar
15.Noble, WC, Virani, Z, Cree, RG. Co-transfer of vancomycin and other resistance genes from EnterococcusfaecalisNCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett 1992;72:195–198.CrossRefGoogle ScholarPubMed
16.Weigel, LM, Donlan, RM, Shin, DH, et al.High-level vancomycin-resistant Staphylococcus aureus isolates associated with a polymicrobial biofilm. Antimicrob Agents Chemother 2007;51:231–238.CrossRefGoogle ScholarPubMed
17.Warren, DK, Nitin, A, Hill, C, et al.Occurrence of co-colonization or co-infection with vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2004;25:99–104.Google Scholar
18.Furuno, JP, Perencevich, EN, Johnson, JA, et al.Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci co-colonization. Emerg Infect Dis 2005;11:1539–1544.CrossRefGoogle ScholarPubMed
19.Benson, L, Sprague, B, Campos, J, et al.Epidemiology of infection and colonization with vancomycin-resistant enterococci and frequency of co-colonization with methicillin-resistant Staphylococcus aureus in children. Infect Control Hosp Epidemiol 2007;28:880–882.CrossRefGoogle Scholar
20.Domig, KJ, Mayer, HK, Kneifel, W. Methods used for the isolation, enumeration, characterisation and identification of Enterococcus spp. 1. Media for isolation and enumeration. Int J Food Microbiol 2003;88:147164.Google Scholar
21.Domig, KJ, Mayer, HK, Kneifel, W. Methods used for the isolation, enumeration, characterisation and identification of Enterococcus spp. 2. Pheno- and genotypic criteria. Int J Food Microbiol 2003;88:165–188.Google Scholar
22.Kloos, WE, Bannerman, TL. Staphylococcus and Micrococcus. In: Murray, PR, Baron, EJ, Pfaller, MA, et al. eds. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology; 1999:264–282.Google Scholar
23.Koneman, EW, Allen, SD, Janda, WM, et al.The Cram-Positive Cocci: part 1: staphylococci and related genera. Philadelphia: Lippincott-Raven; 1997:539–576.Google Scholar
24.CLSI. Performance standards for antimicrobial disk susceptibility testing: 16th informational supplement. CLSI document. Wayne, PA: CLSI; 2007:M100-S17.Google Scholar
25.Charlson, ME, Pompei, P, Ales, KL, et al.A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.Google Scholar
26.McGregor, JC, Kim, PW, Perencevich, EN, et al.Utility of the Chronic Disease Score and Charlson Comorbidity Index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms. Am J Epidemiol 2005;161:483–493.Google Scholar
27.Knaus, WA, Draper, EA, Wagner, DP, et al.APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.Google Scholar
28.Garner, JS, Jarvis, WR, Emori, TG, et al.CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
29.Zirakzadeh, A, Patel, R. Vancomycin-resistant enterococci: colonization, infection, detection, and treatment. Mayo Clin Proc 2006;81:529–536.CrossRefGoogle ScholarPubMed
30.Hughes, WT, Armstrong, D, Bodey, GP, et al.2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002;34:730–751.CrossRefGoogle ScholarPubMed
31.World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. 2nd ed. Geneva:World Health Organization; 2006.Google Scholar
32.Christensen, BB, Sternberg, C, Andersen, JB, et al.Establishment of new genetic traits in a microbial biofilm community. Appl Environ Microbiol 1998;64:2247–2255.CrossRefGoogle Scholar
33.Hausner, M, Wuertz, S. High rates of conjugation in bacterial biofilms as determined by quantitative in situ analysis. Appi Environ Microbiol 1999;65:3710–3713.CrossRefGoogle ScholarPubMed
34.Miyake, M, Ohbayashi, Y, Iwasaki, A, et al.Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and use of a nasal mupirocin ointment in oral cancer inpatients. J Oral Maxillofac Surg 2007;65:2159–2163.Google Scholar
35.Tenover, FC, Weigel, LM, Appelbaum, PC, et al.Vancomycin-resistant Staphylococcus aureus isolate from a patient in Pennsylvania. Antimicrob Agents Chemother 2004;48:275–280.Google Scholar