Korean J Nosocomial Infect Control.  2015 Jun;20(1):19-28. 10.14192/kjnic.2015.20.1.19.

Risk Factors for Prolonged Carriage and Reacquisition of Vancomycin-resistant Enterococci

• Lee D
• Park ES
• Yong D
• Choi JY
• Lee K
• Jee SH

• KMID: 2078886
• DOI: http://doi.org/10.14192/kjnic.2015.20.1.19

Abstract

BACKGROUND
Patients infected with vancomycin-resistant enterococci (VRE) are kept in isolation to prevent the spread of VRE in medical facilities. However, decision-making regarding isolation can be challenging at the time of re-admission of previously VRE-colonized or infected patients who have not been examined for VRE infections for a long time. This study focused on providing guidelines for isolating VRE patients based on the analysis of risk factors for prolonged carriage and reacquisition of VRE.
METHODS
A retrospective review was performed on medical records of patients who were diagnosed with VRE infections at a university hospital in 2009. Durations of colonization and negative conversion of VRE were estimated by Kaplan-Meier methods. Prolonged duration of VRE infections and risk factors for reacquisition were analyzed using Cox's proportional hazard model.
RESULTS
Among 220 VRE-colonized patients, 132 were cleared, and 30 reacquired after negative conversion of VRE. The median duration of colonization was 33.1 weeks, and the median clearance period was 19.4 weeks. Patients who were admitted via the emergency department and treated with glycopeptides tended to have prolonged duration of VRE colonization. Prolonged hospitalization and metronidazole therapy increased the risk of reacquisition more rapidly.
CONCLUSION
Treatment with glycopeptides, metronidazole antibiotic therapy, history of admission via the emergency department, and prolonged hospitalization can affect to prolonged carriage and reacquisition of VRE. Consider carefully the release of isolation of VRE patients with these risk factors.

Keyword

Colonization; Enterococcus; Patient isolation; Vancomycin resistance

MeSH Terms

Colon
Emergency Service, Hospital
Enterococcus
Glycopeptides
Hospitalization
Humans
Medical Records
Metronidazole
Patient Isolation
Proportional Hazards Models
Retrospective Studies
Risk Factors*
Vancomycin Resistance
Glycopeptides
Metronidazole

Figure

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  Fig. 1. Clearance and reacquisition of VRE. *124 clearance and 29 reacquisition, when culture used to ChromID VRE media performed. 8 clearance and 1 reacquisition, when PCR assay performed. The difference of VRE reacquisition due to the VRE test method was not significant (P=1.000); †Condition1 is basic condition of VRE clearance and condition2 is modified condition; The difference of VRE reacquisition due to the clearance condition of VRE was not significant (P=0.538).

• 

  Fig. 2. Kaplan-Meier curve: Estimated duration of VRE colonization. Abbreviation: CI, confidence interval.

• 

  Fig. 3. Kaplan-Meier curve: Estimated duration of free VRE. Abbreviation: See Fig. 2.

Reference

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