Epidemiology of Vancomycin-Resistant Enterococcus faecium and Enterococcus faecalis Colonization in Nursing Facilities

Abstract

Background Vancomycin-resistant Enterococcus faecium and Enterococcus faecalis frequently colonize nursing facility (NF) residents, creating opportunities for vancomycin-resistant Enterococcus (VRE) transmission and dissemination of mobile genetic elements conferring antimicrobial resistance. Most VRE studies do not speciate; our study addresses this lack and compares the epidemiology of E faecium and E faecalis. Methods We enrolled 651 newly admitted patients from 6 different NFs and collected swabs from several body sites at enrollment, 14 days, 30 days, and monthly thereafter for up to 6 months. The VRE were speciated using a duplex polymerase chain reaction. We used multinomial logistic regression models to compare risk factors associated with colonization of E faecium and E faecalis. Results Overall, 40.7% were colonized with E faecium, E faecalis, or both. At enrollment, more participants were colonized with E faecium (17.8%) than E faecalis (8.4%); 3.2% carried both species. Enterococcus faecium was carried twice as long as E faecalis (69 days and 32 days, respectively), but incidence rates were similar (E faecium, 3.9/1000 person-days vs E faecalis, 4.1/1000 person-days). Length of stay did not differ by species among incident cases. Residents who used antibiotics within the past 30 days had a greater incidence of both E faecium (odds ratio [OR] = 2.89; 95% confidence interval [CI], 1.82–4.60) and E faecalis (OR = 1.80; 95% CI, 1.16–2.80); device use was most strongly associated with the incidence of E faecium colonization (OR = 2.01; 95% CI, 1.15–3.50). Conclusions Recent increases in vancomycin-resistant E faecium prevalence may reflect increased device use and longer duration of carriage.

A systematic review and meta-analysis on the prevalence of vancomycin-resistant enterococci (VRE) among Nigerians

“…This conforms to a report from a study from the United States that reported a higher prevalence of E faecium from clinical settings. 39 Many studies around the world have, however, reported the predominance of E faecalis in clinical infections. 40 – 42 Differences in the geographical region can be a major factor in this variation.…”

“… 43 An increase in E faecium prevalence in clinical infections have been linked to increase in the use of medical devices and increased duration of carriage. 39 …”

Vancomycin-Resistant Enterococci (VRE) in Nigeria: The First Systematic Review and Meta-Analysis

“…Because resistance to vancomycin is more regular in homogenous E. faecalis , administering of beta lactams should be at the forefront before the use of conventional culture [ 56 ]. Arias and Murray [ 57 ] and Davis et al [ 58 ] stated that most VRE infections were caused by E. faecalis . This has changed as more VRE caused by E. faecium are increasingly being reported [ 59 , 60 , 61 ] because of their resistance to different group of antibiotics which are mostly expensive [ 62 , 63 ].…”

In Vitro Evaluation of Antibacterial and Antifungal Properties of Some New 1, 3, 4-Oxadiazole Derivatives Containing Phenyl Group

“…These bacteria are known as the fourth leading cause of nosocomial infections, the third leading cause of bacteremia infections, and the second leading cause of urinary tract infections [5] . Various studies have shown antibiotic resistance of this bacterial species [6] . Proteus bacilli are also optional Gram-negative bacilli belonging to the group of Proteobacteria and aerobic anaerobes [7] .…”