Predictors for vancomycin resistant Enterococcus faecium transforming from colonization to infection: a case control...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Epidemiology

Background:

• Vancomycin-resistant Enterococcus faecium (VREfm) colonization is a known risk factor for subsequent infection.
• Limited data exist on specific risk factors for VREfm infection among colonized individuals, particularly those with concordant pulsotypes (CP) between colonization and infection isolates.

Purpose of the Study:

• To identify risk factors for subsequent VREfm infections in VREfm colonizers.
• To investigate the role of concordant pulsotypes (CP) in VREfm infection development.

Main Methods:

• A case-control study was conducted from 2011-2014 at a teaching hospital.
• Patients were screened for VREfm colonization via anal swabs upon admission.
• Cases developed VREfm infection within 180 days of colonization; controls were colonized without infection. Concordant pulsotypes (CP) were defined by ≥86.7% similarity using pulsed-field gel electrophoresis.

Main Results:

• Ninety-seven cases and 194 controls were analyzed.
• Risk factors for VREfm infection included ICU admission (aOR, 9.32), central venous catheter (CVC) use (aOR, 3.38), and third- (aOR, 4.06) or fourth-generation cephalosporin use (aOR, 5.32).
• Of the cases, 57.7% had CP, which were associated with ICU admission (aOR, 3.74) and infection within 30 days of colonization (aOR, 3.34).

Conclusions:

• ICU admission, CVC, and broad-spectrum cephalosporins are significant risk factors for VREfm infection among VREfm colonizers.
• The findings underscore the need for enhanced infection control measures targeting specific VREfm colonizer populations, especially those with CP.