1. Epidemiology of Vancomycin-Resistant Enterococcus faecalis: a Case-Case-Control Study
- Author
-
Michael J. Rybak, Manoj Das, Venkat Ram Rakesh Mundra, Keith S. Kaye, Rajiv Doddamani, Naveen Kannekanti, Sharan Lohithaswa, Aditya Govindavarjhulla, Sowmya Chidurala, Uma Mahesh Gudur, Dror Marchaim, Deepti Chowdary, Kayoko Hayakawa, Harish Pulluru, Khaled Alshabani, Praveen Vemuri, Emily T. Martin, Jason M. Pogue, Shiva Prasad Shashidharan, Sreelatha Diviti, Pradeep Bathina, Hari Kakarlapudi, Harish Guddati, Raviteja R. Guddeti, Krishna Sukayogula, Rohan Policherla, Deepika Reddy Abbadi, Sarika Bai, Melwin Joseph, Ashwini Mallad, Paul R. Lephart, and Mohan Palla
- Subjects
Male ,Michigan ,medicine.medical_specialty ,medicine.drug_class ,Cephalosporin ,Comorbidity ,Microbial Sensitivity Tests ,Drug resistance ,medicine.disease_cause ,Enterococcus faecalis ,Epidemiology and Surveillance ,Microbiology ,Cohort Studies ,Immunocompromised Host ,Catheters, Indwelling ,Risk Factors ,Drug Resistance, Multiple, Bacterial ,Internal medicine ,Epidemiology ,Diabetes Mellitus ,medicine ,Humans ,Infection control ,Pharmacology (medical) ,Gram-Positive Bacterial Infections ,Aged ,Aged, 80 and over ,Pharmacology ,biology ,business.industry ,Age Factors ,Case-control study ,Vancomycin Resistance ,Middle Aged ,biology.organism_classification ,Anti-Bacterial Agents ,Cephalosporins ,Infectious Diseases ,Staphylococcus aureus ,Case-Control Studies ,Female ,business ,Fluoroquinolones ,Enterococcus faecium - Abstract
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.
- Published
- 2013
- Full Text
- View/download PDF