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Predictors for vancomycin resistant Enterococcus faecium transforming from colonization to infection: a case control
Pao-Yu Chen1,2, Yu-Chung Chuang1, Jann-Tay Wang1,3
11Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan 100.
Background:
Little is known about risk factors for subsequent infections among vancomycin resistant Enterococcus faecium (VREfm) colonizers, especially characterized by concordant pulsotypes (CP) of paired colonization and infection-related isolates.
Methods:
This case-control study was conducted at a teaching hospital between 2011 and 2014. Targeted patients received active surveillance culture for VREfm by anal swabs at admission. Cases were those who developed VREfm infection within 180 days after colonization of VREfm. Controls were those colonized with VREfm without subsequent VREfm infection. CP were defined by similarities ≥86.7% using pulsed-field gel electrophoresis between paired colonization and infection-related isolates.
Results:
Ninety-seven cases and 194 controls were enrolled. By conditional multivariable logistic regression analysis, the risk factors for subsequent infection among VREfm colonizers were intensive care unit (ICU) admission (adjusted odds ratio [aOR], 9.32; 95% CI, 3.61-24.02), receipt of central venous catheters (CVC) (aOR, 3.38; 95% CI, 1.30-8.82), and utilization of third- and fourth-generation cephalosporins (aOR, 4.06; 95% CI, 1.79-9.20, and aOR, 5.32; 95% CI, 1.85- 10.29, respectively) (all P ≤ 0.01). Fifty-six (57.7%) of case patients belonged to the CP group, which were associated with ICU admission (aOR, 3.74; 95% CI, 1.38-10.13), and infection developing within 30 days after colonization (aOR, 3.34; 95% CI, 1.25-8.91).
Conclusions:
Among VREfm colonizers, being admitted to ICU and receiving CVC or broad spectrum cephalosporins, were the risk factors for subsequent infections. These findings highlight the importance of conducting more strict infection control measures on specific groups of VREfm colonizers.
Insights
Intensive care unit (ICU) admission, central venous catheters (CVC), and cephalosporin use increase the risk of vancomycin-resistant Enterococcus faecium (VREfm) infection in colonized patients. Strict infection control is crucial for high-risk VREfm colonizers.
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.
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