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Antimicrob Agents Chemother. Epidemiology of vancomycin-resistant Enterococcus faecalis: a case-case-control study
[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]
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Epidemiology of vancomycin-resistant Enterococcus faecalis: a case-case-control study [PublishAheadOfPrint]
Hayakawa, K., Marchaim, D., Palla, M., Mahesh Gudur, U., Pulluru, H., Bathina, P., Alshabani, K., Govindavarjhulla, A., Mallad, A., Reddy Abbadi, D., Chowdary, D., Kakarlapudi, H., Guddati, H., Das, M., Kannekanti, N., Vemuri, P., Doddamani, R., Ram Rakesh Mundra, V., Reddy Guddeti, R., Policherla, R., Bai, S., Lohithaswa, S., Prasad Shashidharan, S., Chidurala, S., Diviti, S., Sukayogula, K., Joseph, M., Pogue, J. M., Lephart, P. R., Martin, E. T., Rybak, M. J., Kaye, K. S.
Background:
Although much is known about vancomycin-resistant Enterococcus faecium, little is known about the epidemiology of vancomycin-resistant Enterococcus faecalis. The predilection of VRE. faecalis to transfer the vancomycin resistance determinant to Staphylococcus aureus is much greater compared to VRE. faecium. The epidemiology of VRE. faecalis has important implications regarding the emergence of vancomycin-resistant S. aureus (VRSA); 8 out of 12 reported VRSA cases have been from Michigan.
Methods:
A retrospective case-case-control study was conducted at Detroit Medical Center located in southeast Michigan. Unique patients with VRE. faecalis were matched to cases with strains of vancomycin- susceptible E. faecalis (VSE. faecalis) and to uninfected controls in a 1:1:1 ratio.
Results:
Five-hundred thirty-two VRE. faecalis cases were identified and were matched to 532 VSE. faecalis cases and 532 uninfected controls. The overall mean age of the study cohort (n=1596) was 63.0?17.4 years, 747 (46.8%) were male. Independent predictors for the isolation of VRE. faecalis (but not for VSE. faecalis) as compared to uninfected controls were age ≥65, non-home residence, diabetes mellitus, peripheral vascular disease, exposure to cephalosporins and fluoroquinolones in the prior 3 months, immunosuppressive status. Invasive procedure and/or surgery, chronic skin ulcer, and indwelling devices were risk factors for both VRE. faecalis and VSE. faecalis.
Conclusions:
Cephalosporins and fluoroquinolones exposures were unique, independent predictors for isolation of VRE. faecalis. A majority of cases had VRE. faecalis present at the time of admission. Control of VRE. faecalis, and ultimately VRSA, will likely require regional efforts focusing on infection prevention and antimicrobial stewardship.
-Hayakawa, K., Marchaim, D., Palla, M., Mahesh Gudur, U., Pulluru, H., Bathina, P., Alshabani, K., Govindavarjhulla, A., Mallad, A., Reddy Abbadi, D., Chowdary, D., Kakarlapudi, H., Guddati, H., Das, M., Kannekanti, N., Vemuri, P., Doddamani, R., Ram Rakesh Mundra, V., Reddy Guddeti, R., Policherla, R., Bai, S., Lohithaswa, S., Prasad Shashidharan, S., Chidurala, S., Diviti, S., Sukayogula, K., Joseph, M., Pogue, J. M., Lephart, P. R., Martin, E. T., Rybak, M. J., Kaye, K. S.
Background:
Although much is known about vancomycin-resistant Enterococcus faecium, little is known about the epidemiology of vancomycin-resistant Enterococcus faecalis. The predilection of VRE. faecalis to transfer the vancomycin resistance determinant to Staphylococcus aureus is much greater compared to VRE. faecium. The epidemiology of VRE. faecalis has important implications regarding the emergence of vancomycin-resistant S. aureus (VRSA); 8 out of 12 reported VRSA cases have been from Michigan.
Methods:
A retrospective case-case-control study was conducted at Detroit Medical Center located in southeast Michigan. Unique patients with VRE. faecalis were matched to cases with strains of vancomycin- susceptible E. faecalis (VSE. faecalis) and to uninfected controls in a 1:1:1 ratio.
Results:
Five-hundred thirty-two VRE. faecalis cases were identified and were matched to 532 VSE. faecalis cases and 532 uninfected controls. The overall mean age of the study cohort (n=1596) was 63.0?17.4 years, 747 (46.8%) were male. Independent predictors for the isolation of VRE. faecalis (but not for VSE. faecalis) as compared to uninfected controls were age ≥65, non-home residence, diabetes mellitus, peripheral vascular disease, exposure to cephalosporins and fluoroquinolones in the prior 3 months, immunosuppressive status. Invasive procedure and/or surgery, chronic skin ulcer, and indwelling devices were risk factors for both VRE. faecalis and VSE. faecalis.
Conclusions:
Cephalosporins and fluoroquinolones exposures were unique, independent predictors for isolation of VRE. faecalis. A majority of cases had VRE. faecalis present at the time of admission. Control of VRE. faecalis, and ultimately VRSA, will likely require regional efforts focusing on infection prevention and antimicrobial stewardship.
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