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

• 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
• DOI: 10.1007/s10096-013-1814-z
• EISSN: 1435-4373
• ISSN: 0934-9723

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