Independent risk factors for the co-colonization of vancomycin-resistant Enterococcus faecalis and methicillin-resistant Staphylococcus aureus in the region most endemic for vancomycin-resistant Staphylococcus aureus isolation

In the majority of cases of vancomycin-resistant Staphylococcus aureus (VRSA), vancomycin-resistant Enterococcus faecalis (VR E. faecalis ) served as the vanA donor to S. aureus . Previous studies that evaluated the risk factors for co-colonization with VRE and MRSA did not differentiate between VR...

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Published in:	European journal of clinical microbiology & infectious diseases Vol. 32; no. 6; pp. 815 - 820
Main Authors:	Hayakawa, K., Marchaim, D., Bathina, P., Martin, E. T., Pogue, J. M., Sunkara, B., Kamatam, S., Ho, K., Willis, L. B., Ajamoughli, M., Patel, D., Khan, A., Lee, K. P., Suhrawardy, U., Jagadeesh, K. K., Reddy, S. M. L., Levine, M., Ahmed, F., Omotola, A. M., Mustapha, M., Moshos, J. A., Rybak, M. J., Kaye, K. S.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer-Verlag 01-06-2013 Springer Springer Nature B.V
Subjects:	Activities of daily living Aged Aged, 80 and over Antibiotic resistance Bacterial diseases Biological and medical sciences Biomedical and Life Sciences Biomedicine Case-Control Studies Coinfection Colonization Drug Resistance, Bacterial Enterococcus faecalis Enterococcus faecalis - drug effects Enterococcus faecalis - isolation & purification Female Gram-Positive Bacterial Infections - epidemiology Hospitals Human bacterial diseases Humans Infectious diseases Internal Medicine Long-term care Male Medical Microbiology Medical sciences Methicillin-Resistant Staphylococcus aureus - drug effects Methicillin-Resistant Staphylococcus aureus - isolation & purification Middle Aged Mortality Odds Ratio Patients Pharmacy Retrospective Studies Risk Factors Staphylococcal Infections - epidemiology Staphylococcal infections, streptococcal infections, pneumococcal infections Staphylococcus aureus Staphylococcus infections Vancomycin - pharmacology United States > US Detroit Michigan Michigan USA, Michigan, Detroit Functional Status Deterioration Surveillance Culture Chronic Skin Ulcer Impaired Consciousness vanA Gene Enterococcus faecalis Microbiology Infection Streptococcaceae Risk factor Bacteriosis Bacteria Micrococcales Isolation Micrococcaceae Staphylococcal infection Colonization Staphylococcus aureus
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Summary:	In the majority of cases of vancomycin-resistant Staphylococcus aureus (VRSA), vancomycin-resistant Enterococcus faecalis (VR E. faecalis ) served as the vanA donor to S. aureus . Previous studies that evaluated the risk factors for co-colonization with VRE and MRSA did not differentiate between VR E. faecalis and VR E. faecium . This study aimed to identify variables associated with VR E. faecalis and MRSA co-colonization. A retrospective case–control study from January 2008 to December 2009 was conducted at the Detroit Medical Center. Data were extracted from charts and pharmacy records. Unique patients co-colonized with VR E. faecalis and MRSA (defined as isolation of MRSA within 7 days of VR E. faecalis isolation) were compared with patients with VR E. faecalis who were not co-colonized with MRSA. A total of 546 patients with VR E. faecalis isolation were identified. 85 (15.6 %) VR E. faecalis patients were co-colonized with MRSA and 461 (84.4 %) VR E. faecalis patients were not co-colonized with MRSA. The mean age of the study cohort was 65.9 ± 16.4 years, 424 (77.7 %) were African–American, and 270 (49.5 %) were residing in long-term care institutions. Independent predictors of co-colonization of VR E. faecalis and MRSA were male gender, impaired consciousness, ICU stay prior to VR E. faecalis isolation, indwelling devices, and isolation of VR E. faecalis from wounds. MRSA was frequently isolated from the same culture specimen as VR E. faecalis ( n = 39, 45.9 %), most commonly from wounds. This large study of patients with VR E. faecalis identified the severity of illness, indwelling devices, and chronic wounds as independent predictors of co-colonization with VR E. faecalis and MRSA
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ISSN:	0934-9723 1435-4373
DOI:	10.1007/s10096-013-1814-z