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Risk factors for enterococcal infection and colonization by vancomycin-resistant enterococci in critically ill patients

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Abstract

Purpose

Vancomycin-Resistant Enterococci (VRE) are important causes of Intensive Care Unit (ICU) infections. Our goal was to identify the prevalence and risk factors for VRE colonization upon ICU admission and during ICU stay, as well as, their impact in enterococcal infection including vancomycin-susceptible cases (VSE).

Methods

A prospective study regarding patients admitted in ICU (n = 497) was conducted during a 24-month period. Rectal swabs were collected upon admission and during hospitalization and inoculated onto selective medium. Enterococci were phenotypically characterized. van genes were investigated by PCR and clones were identified by Pulsed-Field Gel Electrophoresis and Multilocus Sequence Typing. Epidemiologic data were collected from the ICU database.

Results

Risk factors for VRE carriage upon ICU admission (71/497) were: duration of previous hospitalization, glycopeptide administration, chronic heart failure, malignancy, insulin-dependent diabetes mellitus, and previous enterococcal infection (VRE and/or VSE). Risk factors for VRE colonization during ICU stay (36/250) were: quinolone administration, chronic obstructive pulmonary disease, chronic renal failure, and number of VRE-positive patients in nearby beds. Risk factors for enterococcal infection during ICU stay (15/284), including VRE and VSE cases, were: administration of third- or fourth-generation cephalosporins, cortisone use before ICU admission and VRE colonization, whereas, enteral nutrition was a protective factor.

Conclusions

Previous VRE colonization and antibiotic usage are essential parameters for enterococcal infection (by VRE or VSE) during ICU stay. Previous enterococcal infection, co-morbidities and antibiotic usage are associated with VRE colonization upon ICU admission, whereas, patient to patient transmission, co-morbidities and antibiotic usage constitute risk factors for VRE colonization during ICU hospitalization.

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References

  1. Cattoir V, Leclercq R. Twenty-five years of shared life with vancomycin-resistant enterococci: is it time to divorce? J Antimicrob Chemother. 2013;68:731–42.

    Article  CAS  PubMed  Google Scholar 

  2. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report, Reporting on 2011 surveillance data and 2012 epidemic intelligence data. Stockholm: ECDC; 2013. p. 2013.

    Google Scholar 

  3. Werner G, Coque TM, Hammerum AM, et al. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill. 2008;13.

  4. Damani A, Klapsa D, Panopoulou M, et al. A newly described vancomycin-resistant ST412 Enterococcus faecium predominant in Greek hospitals. Eur J Clin Microbiol Infect Dis. 2010;29:329–31.

    Article  CAS  PubMed  Google Scholar 

  5. Sofianou D, Pournaras S, Giosi M, et al. Substantially increased faecal carriage of vancomycin-resistant enterococci in a tertiary Greek hospital after a 4 year time interval. J Antimicrob Chemother. 2004;54:251–4.

    Article  CAS  PubMed  Google Scholar 

  6. Kim YJ, Kim SI, Kim YR, et al. Risk factors for vancomycin-resistant enterococci infection and mortality in colonized patients on intensive care unit admission. Am J Infect Control. 2012;40:1018–9.

    Article  PubMed  Google Scholar 

  7. Ostrowsky BE, Venkataraman L, D’Agata EM, et al. Vancomycin-resistant enterococci in intensive care units: high frequency of stool carriage during a non-outbreak period. Arch Intern Med. 1999;159:1467–72.

    Article  CAS  PubMed  Google Scholar 

  8. Song JY, Cheong HJ, Jo YM, et al. Vancomycin-resistant Enterococcus colonization before admission to the intensive care unit: a clinico-epidemiologic analysis. Am J Infect Control. 2009;37:734–40.

    Article  CAS  PubMed  Google Scholar 

  9. Centers for Disease Control and Prevention. Catheter associated urinary tract infection (CAUTI) event. January 2012. http://www.cdc.gov/nhsn/pdfs/pscManual/7pscCAUTIcurrent.pdf. Accessed August, 2014.

  10. Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically, Approved standard M7-A7. 12th ed. Wayne: CLSI; 2011.

    Google Scholar 

  11. Bell J, Turnidge J, Coombs G, O’Brien F. Emergence and epidemiology of vancomycin-resistant enterococci in Australia. Commun Dis Intell. 1998;22:249–52.

    CAS  PubMed  Google Scholar 

  12. Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  13. Christidou A, Gikas A, Scoulica E, et al. Emergence of vancomycin-resistant enterococci in a tertiary hospital in Crete, Greece: a cluster of cases and prevalence study on intestinal colonisation. Clin Microbiol Infect. 2004;10:999–1005.

    Article  CAS  PubMed  Google Scholar 

  14. Kolar M, Pantucek R, Vagnerova I, et al. Prevalence of vancomycin-resistant enterococci in hospitalized patients and those living in the community in the Czech Republic. New Microbiol. 2006;29:121–5.

    CAS  PubMed  Google Scholar 

  15. Endtz HP, Van Den Braak N, Van Belkum A, et al. Comparison of eight methods to detect vancomycin resistance in enterococci. J Clin Microbiol. 1998;36:592–4.

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Beltrami EM, Singer DA, Fish L, et al. Risk factors for acquisition of vancomycin-resistant enterococci among patients on a renal ward during a community hospital outbreak. Am J Infect Control. 2000;28:282–5.

    Article  CAS  PubMed  Google Scholar 

  17. Batistao DW, Gontijo-Filho PP, Conceicao N, et al. Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients. Mem Inst Oswaldo Cruz. 2012;107:57–63.

    Article  PubMed  Google Scholar 

  18. Goetz AM, Rihs JD, Wagener MM, et al. Infection and colonization with vancomycin-resistant Enterococcus faecium in an acute care Veterans Affairs Medical Center: a 2-year survey. Am J Infect Control. 1998;26:558–62.

    Article  CAS  PubMed  Google Scholar 

  19. MacIntyre CR, Empson M, Boardman C, et al. Risk factors for colonization with vancomycin-resistant enterococci in a Melbourne hospital. Infect Control Hosp Epidemiol. 2001;22:624–9.

    Article  CAS  PubMed  Google Scholar 

  20. Bonten MJ, Slaughter S, Ambergen AW, et al. The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med. 1998;158:1127–32.

    Article  CAS  PubMed  Google Scholar 

  21. Sakka V, Tsiodras S, Galani L, et al. Risk-factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci. Clin Microbiol Infect. 2008;14:14–21.

    Article  CAS  PubMed  Google Scholar 

  22. Ajao AO, Harris AD, Roghmann MC, et al. Systematic review of measurement and adjustment for colonization pressure in studies of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Clostridium difficile acquisition. Infect Control Hosp Epidemiol. 2011;32:481–9.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Ziakas PD, Thapa R, Rice LB, et al. Trends and significance of VRE colonization in the ICU: a meta-analysis of published studies. PLoS One. 2013;8:e75658. doi: 10.1371/journal.pone.0075658. eCollection 2013

  24. Pan SC, Wang JT, Chen YC, et al. Incidence of and risk factors for infection or colonization of vancomycin-resistant enterococci in patients in the intensive care unit. PLoS One. 2012;7:e47297. doi:10.1371/journal.pone.0047297.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Liss BJ, Vehreschild JJ, Cornely OA, et al. Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies. Infection. 2012;40:613–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This research was supported by funding of the Department of Microbiology, School of Medicine, University of Patras, Greece.

Conflict of interest

All authors report no conflicts of interest relevant to this article.

Ethical approval

The study was approved by the University Hospital Ethics Committee that waived the need for informed consent (HEC No: 571).

Author information

Author notes

  1. A. Liakopoulos

    Present address: Central Veterinary Institute (CVI) of Wageningen UR, Lelystad, The Netherlands

Authors and Affiliations

  1. Division of Infectious Diseases, School of Medicine, University of Patras, Rion, 26504, Patras, Greece

    M. Papadimitriou-Olivgeris & M. Marangos

  2. Department of Microbiology, School of Medicine, University of Patras, Rion, 26504, Patras, Greece

    E. Drougka, F. Kolonitsiou, E. D. Anastassiou & I. Spiliopoulou

  3. Department of Anaesthesiology and Critical Care Medicine, University of Patras, Rion, 26504, Patras, Greece

    F. Fligou & K. S. Filos

  4. Department of Microbiology, School of Medicine, University of Thessalia, Biopolis, 41222, Larissa, Greece

    A. Liakopoulos & E. Petinaki

  5. Intensive Care Unit, Saint Andrew’s General Hospital, 26335, Patras, Greece

    V. Dodou

Authors
  1. M. Papadimitriou-Olivgeris
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  2. E. Drougka
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  4. F. Kolonitsiou
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  7. E. D. Anastassiou
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  11. I. Spiliopoulou
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Corresponding author

Correspondence to I. Spiliopoulou.

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Papadimitriou-Olivgeris, M., Drougka, E., Fligou, F. et al. Risk factors for enterococcal infection and colonization by vancomycin-resistant enterococci in critically ill patients. Infection 42, 1013–1022 (2014). https://doi.org/10.1007/s15010-014-0678-1

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  • DOI: https://doi.org/10.1007/s15010-014-0678-1

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