Vancomycin use in surrounding patients during critical illness and risk for persistent colonization with...

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Antimicrobial Stewardship

Background:

• Vancomycin-resistant enterococcus (VRE) poses a significant healthcare challenge.
• The optimal duration for contact precautions for VRE-colonized patients remains unclear.
• Predicting prolonged VRE colonization based solely on individual patient factors is difficult.

Purpose of the Study:

• To investigate the association between unit-level vancomycin use and persistent vancomycin-resistant enterococcus colonization.
• To determine if local antibiotic exposure influences VRE colonization duration in intensive care units (ICUs).

Main Methods:

• A cohort study of adult patients admitted to ICUs was conducted.
• Patients were tested for VRE colonization upon ICU admission.
• The association between unit-level vancomycin use and persistent VRE colonization was analyzed, controlling for patient-level vancomycin use and unit VRE density.

Main Results:

• Higher vancomycin use at the unit level was significantly associated with prolonged VRE colonization (P=0.03).
• This association persisted even after accounting for individual patient vancomycin use.
• Unit-level vancomycin use remained a significant predictor of VRE colonization duration, independent of existing VRE burden within the unit.

Conclusions:

• Unit-level vancomycin use is a significant factor in prolonging vancomycin-resistant enterococcus colonization.
• Antimicrobial stewardship programs focusing on unit-level vancomycin reduction may be crucial for VRE control.
• These findings highlight the importance of considering local antibiotic prescribing patterns in managing VRE in healthcare settings.