Antecedent treatment with different antibiotic agents as a risk factor for vancomycin-resistant Enterococcus

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Hospital Epidemiology

Background:

• Vancomycin-resistant Enterococcus (VRE) is a significant healthcare-associated pathogen.
• Understanding risk factors for VRE colonization and infection is crucial for infection control.
• Previous studies have implicated various factors, including antibiotic exposure, in VRE development.

Purpose of the Study:

• To investigate the association between antecedent antibiotic treatment and the subsequent isolation of vancomycin-resistant Enterococcus (VRE).
• To identify specific antibiotic classes that may increase the risk of VRE positivity in hospitalized patients.

Main Methods:

• A matched case-control study was conducted with 880 inpatients (233 VRE cases and 647 matched controls).
• Matching criteria included hospital location, calendar time, and duration of hospitalization.
• Statistical analysis controlled for admitting diagnosis, coexisting conditions, and prior infections with MRSA or C. difficile.

Main Results:

• Antibiotic treatments associated with VRE positivity included third-generation cephalosporins, metronidazole, and fluoroquinolones.
• These associations remained significant after adjusting for patient characteristics, hospital events, and temporo-spatial factors.
• Treatment with vancomycin was not identified as a risk factor for VRE isolation in this study.

Conclusions:

• Treatment with third-generation cephalosporins, metronidazole, and fluoroquinolones are identified as risk factors for VRE isolation.
• These findings highlight the importance of judicious antibiotic use in preventing VRE emergence.
• Further research may explore de-escalation strategies for these antibiotic classes in high-risk settings.