Epidemiology of Vancomycin-Resistant Enterococcus faecalis: a Case-Case-Control Study

Abstract

e Although much is known about vancomycin-resistant (VR) Enterococcus faecium, little is known about the epidemiology of VR Enterococcus faecalis. The predilection of VR E. faecalis to transfer the vancomycin resistance determinant to Staphylococcus aureus is much greater than that of VR E. faecium. The epidemiology of VR E. faecalis has important implications regarding the emergence of vancomycin-resistant S. aureus (VRSA); 8 of 13 reported VRSA cases have been from Michigan. A retrospective case-case-control study was conducted at the Detroit Medical Center, located in southeastern Michigan. Unique patients with VR E. faecalis infection were matched to patients with strains of vancomycin-susceptible (VS) E. faecalis and to uninfected controls at a 1:1:1 ratio. Five hundred thirty-two VR E. faecalis cases were identified and were matched to 532 VS E. faecalis cases and 532 uninfected controls. The overall mean age of the study cohort (n ‫؍‬ 1,596) was 63.0 ؎ 17.4 years, and 747 (46.8%) individuals were male. Independent predictors for the isolation of VR E. faecalis (but not VS E. faecalis) compared to uninfected controls were an age of >65 years, nonhome residence, diabetes mellitus, peripheral vascular disease, exposure to cephalosporins and fluoroquinolones in the prior 3 months, and immunosuppressive status. Invasive procedures and/or surgery, chronic skin ulcers, and indwelling devices were risk factors for both VR E. faecalis and VS E. faecalis isolation. Cephalosporin and fluoroquinolone exposures were unique, independent predictors for isolation of VR E. faecalis. A majority of case patients had VR E. faecalis present at the time of admission. Control of VR E. faecalis, and ultimately VRSA, will likely require regional efforts focusing on infection prevention and antimicrobial stewardship.

Antimicrobial Susceptibility Pattern and Epidemiology of Female Urinary Tract Infections in South Korea, 2010-2011

“…Morris et al showed that the use of multiple antibiotics could be a risk factor for emerging VRE (43). A definite conclusion from these previous reports and from our data is that antimicrobial stewardship should be required to prevent emerging VRE, as mentioned in a recent case-control study (44).…”

Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

“…Eighteen studies were eligible for inclusion including: 5 multicenter studies reporting the incidence of VRE infections [2,[13][14][15][16] and 13 studies (4 multicenter and 9 single center) evaluating relevant outcomes [17][18][19][20][21][22][23][24][25][26][27][28][29].…”

“…Compared with uninfected patients, patients with VR E. faecalis infections had a 2.8-fold increased risk (11.4% vs 33.9%) [18] of being discharged to a LTCF and patients with CO VR E.…”

“…Prior studies have shown that codes for acute conditions such as infections often overestimate the incidence of these conditions [35,36]. To our knowledge, no published study has validated the ICD- Michigan, where the incidence of VR E. faecalis is higher than other regions [18,37]. Thus, monitoring the regional incidence of VRE could help public health officials assess the potential for emergence and spread of VRSA.…”

Importance Of The Rısk Factors For Vancomycın Resıstant Enterococcus Infectıon/Colonızatıon Development In Tertıary Intensıve Care Unıts

“…Several studies demonstrated that long hospitalization periods cause increased risk of colonization, higher rates of morbidity and mortality and cost [21][22][23][24] . In a study by Pan et al, long stay in the intensive care unit was found as a major risk factor for VRE colonization 22 .…”