Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Hospital Epidemiology

Background:

• Vancomycin-resistant enterococci (VRE) are significant hospital-acquired pathogens.
• VRE prevalence is increasing, especially in intensive care unit (ICU) settings.
• Understanding VRE colonization and associated risk factors is crucial for infection control.

Purpose of the Study:

• To determine the incidence of VRE colonization among ICU patients.
• To identify independent risk factors associated with VRE colonization in the ICU.
• To investigate the specific epidemiology of vanC VRE in hospitalized patients.

Main Methods:

• Active surveillance cultures for VRE fecal carriage were performed in ICU patients.
• A case-control study design was employed to assess risk factors.
• Statistical analysis, including odds ratios (OR), was used to evaluate risk factors.

Main Results:

• A high incidence of VRE colonization (23.1%) was observed, predominantly vanC VRE (Enterococcus gallinarum and Enterococcus casseliflavus).
• Independent risk factors for VRE colonization included nephropathy (OR=13.6), prior antibiotic use (OR=5.5), and carbapenem use (OR=17.3).
• Only one case of vanA VRE colonization (0.3%) was detected.

Conclusions:

• VanC VRE colonization is frequent in ICUs and associated with specific risk factors like nephropathy and prior antibiotic/carbapenem use.
• While vanA and vanB VRE are clinically significant, the epidemiology of vanC VRE warrants further investigation.
• VanC VRE-colonized patients may serve as reservoirs for resistance genes, highlighting the need for better understanding and management.