Risk factors for enterococcal infection and colonization by vancomycin-resistant enterococci in critically ill...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Microbiology

Background:

• Vancomycin-Resistant Enterococci (VRE) are significant pathogens causing Intensive Care Unit (ICU) infections.
• Understanding VRE colonization and infection dynamics is crucial for patient management.

Purpose of the Study:

• To determine the prevalence and risk factors for VRE colonization on ICU admission and during ICU stay.
• To assess the impact of VRE and Vancomycin-Susceptible Enterococci (VSE) on enterococcal infections within the ICU.

Main Methods:

• Prospective study of 497 ICU patients over 24 months.
• Rectal swabs collected on admission and during hospitalization for enterococci detection.
• Phenotypic characterization, PCR for van genes, and molecular typing (PFGE, MLST) for strain identification.

Main Results:

• VRE carriage on admission linked to prior hospitalization, glycopeptide use, heart failure, malignancy, diabetes, and prior enterococcal infection.
• VRE colonization during ICU stay associated with quinolone use, COPD, renal failure, and proximity to VRE-positive patients.
• Enterococcal infection risk factors included cephalosporin/cortisone use and VRE colonization; enteral nutrition showed a protective effect.

Conclusions:

• Previous VRE colonization and antibiotic use are key factors for enterococcal infections (VRE/VSE) in ICUs.
• VRE colonization on admission is associated with prior infection, comorbidities, and antibiotic history.
• Patient-to-patient transmission, comorbidities, and antibiotic use drive VRE colonization during ICU hospitalization.