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Factors affecting vancomycin-resistant Enterococcus faecium colonization of in-hospital patients in different wards
Yun-Cheng Wang1, Lih-Shinn Wang2, Tsung-Cheng Hsieh3
1Department of Infection Prevention and Control, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Objectives:
The prevalence of vancomycin-resistant Enterococcus faecium (VRE) infection at a medical center in Eastern Taiwan rose to 80.6%, exceeding the average prevalence of 55.6% among all medical centers nationwide during the same period. In recent years, the number of cases of VRE infection detected among hospitalized patients has increased annually. However, most of these patients in different wards are asymptomatic carriers. Therefore, restricting active screening to high-risk units will not improve the current situation, and it is necessary to review the risk factors for VRE colonization to provide a reference for future infection control policies.
Materials And Methods:
Between 2014 and 2019, there were 3188 VRE-positive cultures reported at our institution, as per the electronic medical records system.
Results:
In the medical and surgical wards, patients who received penicillin (odds ratios [ORs]: 2.84 and 4.16, respectively) and third-generation cephalosporins (ORs: 3.17 and 6.19, respectively) were at higher risk of VRE colonization. In intensive care units, the use of carbapenems (OR: 2.08) was the most significant variable.
Conclusion:
This study demonstrated that the risk factors for VRE colonization differed between wards. Thus, policies should be established according to the attributes of patients in each ward, and active screening tests should be performed according to individual risks, instead of a policy for comprehensive mass screening.
Insights
Vancomycin-resistant Enterococcus faecium (VRE) infection rates are high in Taiwan. Risk factors for VRE colonization vary by hospital ward, necessitating individualized screening and tailored infection control policies.
Area of Science:
- Infectious Diseases
- Epidemiology
- Clinical Microbiology
Background:
- Rising prevalence of vancomycin-resistant Enterococcus faecium (VRE) infections in Taiwan, reaching 80.6% at a regional medical center, significantly above the national average.
- Increasing annual detection of VRE infections among hospitalized patients, with many cases involving asymptomatic carriers.
- The need to identify specific risk factors for VRE colonization to inform effective infection control strategies beyond broad screening.
Purpose of the Study:
- To investigate the distinct risk factors associated with vancomycin-resistant Enterococcus faecium (VRE) colonization across different hospital wards.
- To provide evidence-based recommendations for refining infection control policies and screening protocols for VRE.
Main Methods:
- Retrospective analysis of 3188 VRE-positive cultures reported between 2014 and 2019.
- Utilizing electronic medical records to identify patient data and antibiotic exposure.
- Statistical analysis to determine odds ratios for VRE colonization based on antibiotic use in various hospital settings.
Main Results:
- Penicillin and third-generation cephalosporin use were significant risk factors for VRE colonization in medical and surgical wards (ORs 2.84-6.19).
- Carbapenem use emerged as the most significant risk factor for VRE colonization in intensive care units (OR 2.08).
- Identified distinct antibiotic-associated risk factors for VRE colonization between different hospital wards.
Conclusions:
- Risk factors for VRE colonization are ward-specific, indicating that a one-size-fits-all approach to screening and control is insufficient.
- Infection control policies should be tailored to the specific patient population and antibiotic usage patterns within each ward.
- Active VRE screening should be risk-stratified based on individual patient factors rather than implemented as a universal screening measure.
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