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Enteric carriage of vancomycin-resistant Enterococcus faecium in patients tested for Clostridium difficile
J M Garbutt1, B Littenberg, B A Evanoff
1Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Objective:
To identify independent risk factors for enteric carriage of vancomycin-resistant Enterococcus faecium (VREF) in hospitalized patients tested for Clostridium difficile toxin.
Design:
Retrospective case-cohort study.
Setting:
Tertiary-care teaching hospital.
Patients:
Convenience sample of 215 adult inpatients who had stool tested for C difficile between January 29 and February 25, 1996.
Results:
41 (19%) of 215 patients had enteric carriage of VREE Five independent risk factors for enteric VREF were identified: history of prior C difficile (odds ratio [OR], 15.21; 95% confidence interval [CI95], 3.30-70.10; P < .001), parenteral treatment with vancomycin for > or = 5 days (OR, 4.06; CI95, 1.54-10.73; P = .005), treatment with antimicrobials effective against gram-negative organisms (OR, 3.44; CI95, 1.20-9.87; P = .021), admission from another institution (OR, 2.95; CI95, 1.21-7.18; P =.017), and age > 60 years (OR 2.57; CI95, 1.13-5.82; P = .024). These risk factors for enteric VREF were independent of the patient's current C difficile status.
Conclusions:
Antimicrobial exposures are the most important modifiable independent risk factors for enteric carriage of VREF in hospitalized patients tested for C difficile.