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Vancomycin-resistant Enterococcus faecium in a Veterans Affairs Medical Center: association with antibiotic usage

L L Dever1, C China, R H Eng

  • 1Infectious Diseases Section, Department of Veterans Affairs Medical Center, East Orange, NJ 07018, USA.

American Journal of Infection Control
|March 21, 1998
PubMed
Abstract

Insights

Increased antibiotic use on hospital units is linked to vancomycin-resistant Enterococcus faecium (VREF) infections. Tracking antibiotic usage ratios can help identify infection risks and inform prevention strategies.

Area of Science:

  • Infectious Diseases
  • Hospital Epidemiology
  • Antimicrobial Stewardship

Background:

  • Vancomycin-resistant Enterococcus faecium (VREF) infections are a growing concern, often linked to individual antibiotic use.
  • Previous studies focused on individual patient antibiotic exposure, necessitating an examination of aggregate usage patterns.

Purpose of the Study:

  • To investigate the association between aggregate antibiotic usage on nursing units and the incidence of VREF infections.
  • To determine if hospital-wide antibiotic usage metrics correlate with VREF colonization and infection rates.

Main Methods:

  • A retrospective correlation study was conducted using antibiotic usage data and VREF infection rates from a Veterans Affairs Medical Center.
  • An Average Usage Ratio (AUR) was calculated for each nursing unit to quantify aggregate antibiotic consumption relative to hospital-wide use.
  • Univariate and multivariate regression analyses correlated AUR with VREF incidence, controlling for unit characteristics.

Main Results:

  • A strong positive correlation was observed between the Average Usage Ratio (AUR) and VREF recovery on nursing units.
  • While univariate analysis showed associations for all tested antibiotics, only clindamycin remained significant in multivariate models due to inter-antibiotic usage correlations.
  • Intensive care, acute care, and smaller units had higher VREF infection rates compared to subacute or larger units.

Conclusions:

  • Higher aggregate antibiotic use on nursing units is significantly associated with an increased incidence of VREF infections.
  • Antibiotic usage ratios offer a practical method for assessing the link between antibiotic consumption and nosocomial infections.
  • Findings underscore the importance of antimicrobial stewardship at the unit level to mitigate VREF spread.

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