Comparative Epidemiology of Vancomycin-Resistant Enterococci Colonization in an Acute-Care Hospital and Its Affiliated Intermediate- and Long-Term Care Facilities in Singapore

Abstract

Vancomycin-resistant enterococci (VRE) are an important cause of nosocomial infections in acute-care hospitals (ACHs), intermediate-care facilities (ITCFs), and long-term care facilities (LTCFs). This study contemporaneously compared the epidemiology and risk factors for VRE colonization in different care settings in a health care network. We conducted a serial cross-sectional study in a 1,700-bed ACH and its six closely affiliated ITCFs and LTCFs in June and July of 2014 to 2016. Rectal swab or stool specimens were cultured for VRE. Multivariable logistic regression was used to assess for independent risk factors associated with VRE colonization. Of 5,357 participants, 523 (9.8%) were VRE colonized. VRE prevalence was higher in ACHs (14.2%) than in ITCFs (7.6%) and LTCFs (0.8%). Common risk factors between ACHs and ITCFs included prior VRE carriage, a longer duration of antibiotic therapy, surgery in the preceding 90 days, and the presence of a skin ulcer. Independent risk factors specific to ACH-admitted patients were prior methicillin-resistant carriage, a higher number of beds per room, prior proton pump inhibitor use, and a length of stay of>14 days. For ITCFs, a length of stay of >14 days was inversely associated with VRE colonization. Similarities and differences in risk factors for VRE colonization were observed between health care settings. VRE prevention efforts should target the respective high-risk patients.

Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms

“…McNeil et al, 2006 47 Tan et al, 2018 55 Subtotal (95% CI) Heterogeneity: τ 2 = 0.44; χ 2 = 7.21, df = 2 (P =.03); I 2 = 72% Test for overall effect: z = 2.22 (P = .03) The results from our sensitivity analyses, in which we address the risk of bias and confounding, buttress these findings. Acid suppressants may promote colonization with MDROs through 3 different mechanisms.…”

“…In the primary analysis, we included the 12 studies that adjusted for confounding. [8][9][10]37,39,40,43,45,47,54,55,57 This showed that acid suppression was associated with MDRO colonization (OR = 1.74; 95% CI, 1.40-2.16) ( Figure 2). Among these studies, heterogeneity, as measured using the I 2 method, was 68%.…”

“…58 The risk associated with PPI use was larger than the risk associated with H 2 RAs. However, the number of studies of H 2 RAs was small (n = 4), 9,10,37,55 and the CI of the estimate was large. Therefore, to clearly define a difference in the associations of PPIs and H 2 RAs with MDRO colonization, more studies of H 2 RAs are needed.…”

“…[8][9][10]37,39,40,43,45,47,54,55,57 Overall, the 12 studies included 22 305 participants (8491 [38.1%] were acid suppressant users; 12 714 [57.0%] were female). Of these, 7 studies were cross-sectional, 9,10,37,43,45,55,57 3 were case control, 39,40,54 and 2 were cohort studies. 8,47 We summarized the study characteristics in the Table. Studies were published between 1996 and 2019; most were of adult populations (age ≥18 years).…”

Ten-year narrative review on antimicrobial resistance in Singapore

“…(40) Unfortunately, resistance to the few antibiotics with activity against VRE has started to emerge, and VRE carriage rates appear to have increased since 2010. (41,42)…”