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Gut colonization with vancomycin-resistant Enterococcus and risk for subsequent enteric infection
Jordan E Axelrad1,2, Benjamin Lebwohl2, Edward Cuaresma2
11Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, NYU Langone Health, 240 East 38th Street, 23rd Floor, New York, NY USA.
Gut Pathogens
|July 14, 2018
Summary
Vancomycin-resistant Enterococcus (VRE) colonization in ICU patients was linked to a lower risk of acquiring other enteric infections. This suggests VRE may offer some protection against common gut pathogens.
Area of Science:
- Infectious Diseases
- Microbiology
- Critical Care Medicine
Background:
- Gut colonization with vancomycin-resistant Enterococcus (VRE) is a known risk factor for adverse patient outcomes.
- Understanding the impact of VRE colonization on the acquisition of other enteric pathogens is crucial for infection control.
Purpose of the Study:
- To evaluate the effect of VRE colonization on the subsequent risk of acquiring common enteric pathogens in intensive care unit (ICU) patients.
- To investigate the relationship between VRE colonization and the incidence of gastrointestinal infections.
Main Methods:
- A retrospective cohort study was conducted on adult ICU patients from 2012 to 2017.
- Patients were screened for VRE colonization and underwent stool testing using a gastrointestinal pathogen PCR panel, with or without Clostridium difficile testing.
- Cox proportional hazards modeling was employed to adjust for confounding factors.
Main Results:
- VRE colonization was identified in 17% of patients.
- Patients with VRE colonization showed a significantly lower likelihood of testing positive for other enteric pathogens (9.2% vs. 18%, p=0.01), including E. coli and viral infections.
- While not statistically significant, there was a trend towards increased C. difficile infections in VRE-colonized patients (15% vs. 10%, p=0.11).
- Multivariable analysis confirmed a decreased risk of positive GI PCR in VRE-colonized patients (aHR 0.47, p=0.02), persisting over 5 years.
Conclusions:
- VRE colonization is associated with a reduced risk of subsequent non-Clostridium difficile enteric infections.
- The findings suggest that VRE may exert a protective effect against the acquisition of common enteric pathogens, potentially through gut microbiome dominance.
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