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Risk factors for enterococcal urinary tract infection and colonization in a rehabilitation facility
1Wayne State University, Rehabilitation Institute of Michigan, Detroit 48201, USA.
Background:
We attempted to define the risk factors for urinary tract acquisition of enterococcus in a 155-bed rehabilitation facility in Southeastern Michigan by performing a prospective, case-controlled observational study.
Methods:
All cases were identified from daily review of microbiologic records of urine culture results. All urinary isolates of enterococcus species, whether representing infection or colonization, were saved on agar plates for subsequent pulsed-field gel electrophoresis. Thirty-five percent of urinary tract isolates were due to enterococcal species compared with 5% to 15% in adjacent acute-care facilities. A control was defined as the next patient with a nonenterococcal urinary isolate.
Results:
No differences were found between cases and controls with respect to age, sex, admitting diagnosis, voiding habits, symptoms, laboratory values, geographic location, caregivers, or urinary infection versus colonization.
Conclusions:
Prior antibiotic use was more frequent in the patients colonized or infected with enterococcal isolates (78% vs 41%). No evidence was found for a single clone of enterococcal isolates in our facility by DNA analysis, suggesting that the acquisition of enterococcus in the urinary tract was endogenous.
Insights
Prior antibiotic use is a key risk factor for urinary tract enterococcus infections in rehabilitation facilities. DNA analysis suggests endogenous acquisition, not a single clone, impacting patient care strategies.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Enterococcus species are a significant cause of urinary tract infections (UTIs) in healthcare settings.
- Rehabilitation facilities may have unique risk factors for enterococcal UTIs compared to acute-care hospitals.
Purpose of the Study:
- To identify risk factors associated with urinary tract acquisition of enterococcus in a rehabilitation facility.
- To compare the prevalence of enterococcal isolates in a rehabilitation setting versus acute-care facilities.
Main Methods:
- Prospective, case-controlled observational study design.
- Daily review of microbiologic records and urine culture results.
- Pulsed-field gel electrophoresis (PFGE) used for DNA analysis of enterococcal isolates.
Main Results:
- Enterococcus species accounted for 35% of urinary tract isolates, higher than adjacent acute-care facilities (5%-15%).
- No significant differences found between cases and controls regarding demographics, clinical presentation, or care practices.
- Prior antibiotic use was significantly more frequent in patients with enterococcal isolates (78% vs. 41%).
Conclusions:
- Prior antibiotic use is a major risk factor for enterococcus colonization or infection in the urinary tract.
- DNA analysis did not identify a single dominant clone, suggesting endogenous acquisition of enterococcus.
- Findings indicate a need for targeted antibiotic stewardship in rehabilitation facilities to reduce enterococcal UTIs.