Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-06-02T05:39:38.609Z Has data issue: false hasContentIssue false
  • English
  • Français

Resistant Enterococci: A Prospective, Study of Prevalence, Incidence, and Factors Associated With Colonization in a University Hospital

Published online by Cambridge University Press:  02 January 2015

Jeffrey W. Weinstein ,
Matthew Roe ,
Michael Towns ,
Linda Sanders ,
Jackie J. Thorpe ,
G. Ralph Corey  and
Daniel J. Sexton
Jeffrey W. Weinstein
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Matthew Roe
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Michael Towns
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Linda Sanders
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Jackie J. Thorpe
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
G. Ralph Corey
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton*
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
*
Box 3605, Duke University Medical Center, Durham, NC 27710
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the prevalence of gastrointestinal tract colonization with antibiotic-resistant enterococci at ward entry and to study the incidence and risk factors for nosocomial acquisition of colonization with resistant enterococci.

Design:

A prospective cohort study conducted between February 1 and March 15, 1993.

Methods:

Rectal cultures were obtained within 24 hours of admission or transfer onto the study wards and repeated at weekly intervals and at the time of discharge. Patients harboring antibiotic-resistant enterococci at the time of admission or after admission were compared to patients who were not colonized with these organisms. Clinical and epidemiologic risk factors for colonization were abstracted prospectively by daily chart review. Following a univariate analysis of risk factors associated with colonization, a multivariate statistical analysis using three separate models was done.

Setting:

A 1,125-bed, tertiary-care teaching hospital in North Carolina.

Patients:

A total of 350 patients admitted to two general medical wards and the medical intensive care unit during the study period.

Results:

Antibiotic-resistant enterococci were isolated from 52 patients: 19 were colonized at admission to the study, and 33 later acquired resistant strains. At the time of admission, 5.4% of the patients were colonized with ampicillin-resistant enterococci (ARE), including 1.1% that were colonized with vancomycin-resistant enterococci. Prior hospitalization was associated with colonization with ARE at admission (P=.01). Independent risk factors for nosocomial acquisition of ARE included treatment with more than three antibiotics, empiric use of antibiotics, use of third-generation cephalosporins, and the use of enteral tube feedings. Antibiotics used prophylactically were not associated with resistant enterococcal colonization.

Conclusions:

Our data help to elucidate the epidemiology of gastrointestinal tract colonization with resistant enterococci. We hypothesize that surveillance and control programs will be more likely to succeed if targeted at patients receiving more than three antibiotics, empiric antibiotics, and enteral tube feedings.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 1 , January 1996 , pp. 36 - 41
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Murray, BE. The life and times of the enterococcus. Clin Microbiol Rev 1990;3:46–65.Google Scholar
2.Calderwood, SA, Wennersten, C, Moellering, RC, Kunz, LJ, Krogstad, DJ. Resistance to six aminoglycosidic aminocyclitol antibiotics among enterococci; prevalence, evolution, and relationship to synergism with penicillin. Antimicrob Agents Chemother 1977;12:401–405.Google Scholar
3.Murray, BE. Mederski-Samaroi, B. Transferable b-lactamase: a new mechanism for in vitro penicillin resistance in Streptococcus faecalis. J Clin Invest 1988:72:1168–1171.Google Scholar
4.Uttley, AHC, George, RC, Naidoo, J, et al. High level vancomycin resistant enterococci causing hospital infections. Epidemiol Infect 1989;103:173–181.Google Scholar
5.Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin-United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
6.Oster, SE, Chirurgi, VA, Goldberg, AA, Aiken, S, McCabe, RE. Ampicillin-resistant enterococcal species in an acute care hospital. Antimicrob Agents Chemother 1990;34:1821–1823.Google Scholar
7.Coudron, PE, Mayhall, CG, Facklam, RR. et al. Streptococcus faecium outbreak in a neonatal intensive care unit. J Clin Microbiol 1984;20:1044–1048.Google Scholar
8.Axelrod, P, Talbot, GH. Risk factors for acquisition of gentamicin-resistant enterococci: a multivariate analysis. Arch Intern Med 1989;149:1397–1401.Google Scholar
9.Patterson, JE, Zervos, MJ. High-level gentamicin resistance in Enterococcus: microbiology, genetic basis, and epidemiology. Rev Infect Dis 1990;12:644–652.Google Scholar
10.Huycke, MM, Spiegel, CA, Gilmore, MS. Bacteremia caused by hemolytic, high-level gentamicin-resistant Enterococcus faecalis. Antimicrob Agents Chemother 1991;35:1626–1634.Google Scholar
11.Karanfil, LV, Murphy, M, Josephson, A, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195–200.Google Scholar
12.Boyce, JM, Opal, SM, Potter-Bynoe, G, et al. Emergence and nosocomial transmission of ampicillin-resistant enterococci. Antimicrob Agents Chemother 1992;36:1032–1039.Google Scholar
13.Rubin, LG, Tucci, V, Cercenado, E, Eliopoulos, G, Isenberg, HD. Vancomycin-resistant Enterococcus faecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700–705.Google Scholar
14.Boyle, JF, Soumakis, SA, Rendo, A, et al. Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci. J Clin Microbiol 1993;31:1280–1285.Google Scholar
15.Handwerger, S, Raucher, B, Altarac, D, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.Google Scholar
16.Sexton, DJ, Harrell, LJ, Thorpe, JJ, Hunt, DL, Reller, LB. A casecontrol study of nosocomial ampicillin-resistant enterococcal infection and colonization at a university hospital. Infect Control Hosp Epidemiol 1993;14:629–635.Google Scholar
17.Zervos, MJ, Kauffman, CA, Therasse, PM, Bergman, AG, Mikesell, TS, Schaberg, DRNosocomial infection by gentamicin-resistant Streptococcus faecalis. Ann Intern Med 1987;106:687–691.Google Scholar
18.Rhinehart, E, Smith, NE, Wennersten, C, et al. Rapid dissemination of b-lactamase producing, aminoglycoside-resistant Enterococcus faecalis among patients and staff on an infant-toddler surgical ward. N Engl J Med 1990;323:1814–1818.Google Scholar
19.Facklam, RR, Washington, JJ. Streptococcus and related catalase-negative gram-positive cocci. In: Balows, A, Hausler, WJ Jr, Jerrmann, KL, Isenberg, HD, Shadomy, NJ, eds. Manual of Clinical Microbiology. 5th ed. Washington, DC: American Society for Microbiology; 1991:238–257.Google Scholar
20.National Committee for Clinical Laboratory Standards. Approved Standard, M2-A5: Performance Standards for Antimicrobial Disk Susceptibility Tests. 5th ed. Villanova, PA: NCCLS; 1993.Google Scholar
21.National Committee for Clinical Laboratory Standards. Approved Standard, M7-A3: Methods for Dilution-Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 3rd ed. Villanova, PA: NCCLS; 1993.Google Scholar
22.Harrell, FE, Lee, KL, Califf, RM, Pryor, DB, Rosati, RA. Regression modeling strategies for improved prognostic prediction. Stat Med 1984;3:143–152.Google Scholar
23.Harrell, FE. The logists procedure. In: SUGI Supplemental Library Users Guide. Cary, NC: SAS Institute Inc; 1986;5:269–293.Google Scholar