Risk factors for prolonged carriage of vancomycin-resistant enterococcus faecium among patients in intensive care units: A case-control study

Young Kyung Yoon, Seung Eun Lee, Juneyoung Lee, Hyun Jeong Kim, Jeong Yeon Kim, Dae Won Park, Jang Wook Sohn, Ja Kim Min

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Abstract

Objectives: The aim of this study was to identify the risk factors for prolonged carriage of vancomycin-resistant Enterococcus faecium (VREF) in intensive care units (ICUs). Methods: A retrospective case-control study was performed in the ICUs of a university hospital in Korea from September 2006 to July 2009. VREF carriage was identified through weekly active surveillance rectal cultures. Clinical characteristics and the risk factors for VREF acquisition were compared between cases with prolonged VREF carriage (≥5 weeks, n=58) and controls with shorter VREF carriage (<3 weeks, n=36) in a multivariate logistic regression model. The effect of vancomycin consumption on vancomycin-resistant enterococci (VRE) colonization pressure was investigated using time-series analysis with an autoregressive error model. Results: Out of a total of 6327 rectal swab cultures examined, 1915 (30.3%) specimens from 266 patients were positive for VREF. The weekly VRE colonization pressure ranged from 0.77% to 42.42%. Vancomycin use after VREF acquisition significantly increased VREF carriage (adjusted odds ratio=4.09; 95%; confidence interval=1.32-12.65). The case group had higher in-hospital mortality than the control group [21 (36.2%) versus 4 (11.1%), P=0.007]. Increment of VRE colonization pressure was significantly associated with vancomycin consumption of 1week before (i.e. time t-1) (P=0.0028) and moderately associated with that of the corresponding week (i.e. time t) (P=0.0595). Conclusions: Vancomycin use in patients with VREF colonization might prolong the duration of carriage. Restriction of vancomycin use should be strengthened in these patients through infection control measures.

Original languageEnglish
Article numberdkr204
Pages (from-to)1831-1838
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume66
Issue number8
DOIs
Publication statusPublished - 2011 Aug 1

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Enterococcus faecium
Intensive Care Units
Case-Control Studies
Vancomycin
Pressure
Vancomycin-Resistant Enterococci
Logistic Models
Korea
Infection Control
Hospital Mortality

Keywords

  • ICUs
  • Infection control
  • Time-series analysis

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

@article{9d0a8469027444008989218a33bf9f0d,
title = "Risk factors for prolonged carriage of vancomycin-resistant enterococcus faecium among patients in intensive care units: A case-control study",
abstract = "Objectives: The aim of this study was to identify the risk factors for prolonged carriage of vancomycin-resistant Enterococcus faecium (VREF) in intensive care units (ICUs). Methods: A retrospective case-control study was performed in the ICUs of a university hospital in Korea from September 2006 to July 2009. VREF carriage was identified through weekly active surveillance rectal cultures. Clinical characteristics and the risk factors for VREF acquisition were compared between cases with prolonged VREF carriage (≥5 weeks, n=58) and controls with shorter VREF carriage (<3 weeks, n=36) in a multivariate logistic regression model. The effect of vancomycin consumption on vancomycin-resistant enterococci (VRE) colonization pressure was investigated using time-series analysis with an autoregressive error model. Results: Out of a total of 6327 rectal swab cultures examined, 1915 (30.3{\%}) specimens from 266 patients were positive for VREF. The weekly VRE colonization pressure ranged from 0.77{\%} to 42.42{\%}. Vancomycin use after VREF acquisition significantly increased VREF carriage (adjusted odds ratio=4.09; 95{\%}; confidence interval=1.32-12.65). The case group had higher in-hospital mortality than the control group [21 (36.2{\%}) versus 4 (11.1{\%}), P=0.007]. Increment of VRE colonization pressure was significantly associated with vancomycin consumption of 1week before (i.e. time t-1) (P=0.0028) and moderately associated with that of the corresponding week (i.e. time t) (P=0.0595). Conclusions: Vancomycin use in patients with VREF colonization might prolong the duration of carriage. Restriction of vancomycin use should be strengthened in these patients through infection control measures.",
keywords = "ICUs, Infection control, Time-series analysis",
author = "Yoon, {Young Kyung} and Lee, {Seung Eun} and Juneyoung Lee and Kim, {Hyun Jeong} and Kim, {Jeong Yeon} and Park, {Dae Won} and Sohn, {Jang Wook} and Min, {Ja Kim}",
year = "2011",
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language = "English",
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pages = "1831--1838",
journal = "Journal of Antimicrobial Chemotherapy",
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T1 - Risk factors for prolonged carriage of vancomycin-resistant enterococcus faecium among patients in intensive care units

T2 - A case-control study

AU - Yoon, Young Kyung

AU - Lee, Seung Eun

AU - Lee, Juneyoung

AU - Kim, Hyun Jeong

AU - Kim, Jeong Yeon

AU - Park, Dae Won

AU - Sohn, Jang Wook

AU - Min, Ja Kim

PY - 2011/8/1

Y1 - 2011/8/1

N2 - Objectives: The aim of this study was to identify the risk factors for prolonged carriage of vancomycin-resistant Enterococcus faecium (VREF) in intensive care units (ICUs). Methods: A retrospective case-control study was performed in the ICUs of a university hospital in Korea from September 2006 to July 2009. VREF carriage was identified through weekly active surveillance rectal cultures. Clinical characteristics and the risk factors for VREF acquisition were compared between cases with prolonged VREF carriage (≥5 weeks, n=58) and controls with shorter VREF carriage (<3 weeks, n=36) in a multivariate logistic regression model. The effect of vancomycin consumption on vancomycin-resistant enterococci (VRE) colonization pressure was investigated using time-series analysis with an autoregressive error model. Results: Out of a total of 6327 rectal swab cultures examined, 1915 (30.3%) specimens from 266 patients were positive for VREF. The weekly VRE colonization pressure ranged from 0.77% to 42.42%. Vancomycin use after VREF acquisition significantly increased VREF carriage (adjusted odds ratio=4.09; 95%; confidence interval=1.32-12.65). The case group had higher in-hospital mortality than the control group [21 (36.2%) versus 4 (11.1%), P=0.007]. Increment of VRE colonization pressure was significantly associated with vancomycin consumption of 1week before (i.e. time t-1) (P=0.0028) and moderately associated with that of the corresponding week (i.e. time t) (P=0.0595). Conclusions: Vancomycin use in patients with VREF colonization might prolong the duration of carriage. Restriction of vancomycin use should be strengthened in these patients through infection control measures.

AB - Objectives: The aim of this study was to identify the risk factors for prolonged carriage of vancomycin-resistant Enterococcus faecium (VREF) in intensive care units (ICUs). Methods: A retrospective case-control study was performed in the ICUs of a university hospital in Korea from September 2006 to July 2009. VREF carriage was identified through weekly active surveillance rectal cultures. Clinical characteristics and the risk factors for VREF acquisition were compared between cases with prolonged VREF carriage (≥5 weeks, n=58) and controls with shorter VREF carriage (<3 weeks, n=36) in a multivariate logistic regression model. The effect of vancomycin consumption on vancomycin-resistant enterococci (VRE) colonization pressure was investigated using time-series analysis with an autoregressive error model. Results: Out of a total of 6327 rectal swab cultures examined, 1915 (30.3%) specimens from 266 patients were positive for VREF. The weekly VRE colonization pressure ranged from 0.77% to 42.42%. Vancomycin use after VREF acquisition significantly increased VREF carriage (adjusted odds ratio=4.09; 95%; confidence interval=1.32-12.65). The case group had higher in-hospital mortality than the control group [21 (36.2%) versus 4 (11.1%), P=0.007]. Increment of VRE colonization pressure was significantly associated with vancomycin consumption of 1week before (i.e. time t-1) (P=0.0028) and moderately associated with that of the corresponding week (i.e. time t) (P=0.0595). Conclusions: Vancomycin use in patients with VREF colonization might prolong the duration of carriage. Restriction of vancomycin use should be strengthened in these patients through infection control measures.

KW - ICUs

KW - Infection control

KW - Time-series analysis

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U2 - 10.1093/jac/dkr204

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