Factors associated with Vancomycin-resistant Enterococcus acquisition during a large outbreak

Abstract

Between 2013 and 2014 a Vancomycin-resistant Enterococci (VRE) outbreak occurred in a teaching hospital in France. The outbreak was significant possibly due to the lack of implementation of recommended control measures. The aim of this study was to identify the effect of the lack of adherence to control measures for prevention of VRE acquisition in contact patients taking into account individual risk factors. Contact patients (first two months of the outbreak) with VRE acquisition were compared to patients without VRE acquisition (univariate and logistic regression), in terms of institutional characteristics (unit of hospitalization and isolation measures) and risk factors. Between December 2013 and February 2014, 282 contact patients were included in the study. The prevalence of VRE acquisition was 6.4% (18/282). Significant risk factors for VRE acquisition according to logistic regression analysis were; lack of isolation, hospitalization in the same hospital unit as a VRE carrier patient and lack of isolation (RR=856.8, p=0.001), hospitalization in a specific unit (RR=927.4, p=0.002), McCabe score equal to 2 (RR=5233.6, p=0.008), age (RR=1.2 by year, p=0.011), hemodialysis (RR=36.1, p=0.011), central venous catheter (RR=25.4, p=0.021) and surgery (RR=0.012, p=0.007). Antibiotic use was a significant risk factor for VRE acquisition using univariate analysis (p<10). The findings confirm that the factors focused on by the study (lack of isolation and dedicated unit) had a significant effect on VRE acquisition as patient associated factors. It highlights the importance of observance of the guidelines.

First molecular characterization of related cases of healthcare-associated infections involving multidrug-resistant <em>Enterococcus faecium vanA</em> in Algeria

“…The main risk factors for VRE nosocomial acquisition, such as prolonged hospital stay, use of broad-spectrum antimicrobials such as third-generation cephalosporins known to select enterococci due to the intrinsic resistance of enterococci to these antibiotics, severity of underlying diseases, and prior surgery, were found in the four patients included in this study. 2 , 25 – 27 As observed in our study, VRE have been previously isolated from recurrent peritonitis, reported in patients undergoing chronically peritoneal dialysis or ventriculoperitoneal shunt, identified during healthcare-associated bacteremia, particularly in neutropenic patients and elderly, with a high risk of death, and are becoming important pathogens in several infections complicating solid organ transplantation. 25 , 28 – 33 The four VREfm isolates characterized herein were MDR.…”

Risk factors for vancomycin-resistant enterococcus acquisition during a large outbreak in patients aged 65 years and older

“…A first retrospective study was published in 2017 by Djembi et al [5] including all contact patients identified during the first two months of the outbreak. The analysis revealed factors that significantly favored the acquisition of VRE.…”

“…The index case was identified on December 13, 2013, detected by analysis of the liquid contained in the Kehr drain. An initial retrospective study on this outbreak was performed by Djembi et al [5]. The study was conducted in contact patients followed during the first two months of the outbreak and identified significant factors associated with VRE acquisition.…”

Factors associated with acquisition of glycopeptide-resistant enterococci during a single-strain outbreak

“…The significant protective effect of CP was also found by Fossi Djembi et al . [17] but they have not made a genomic comparison of their strains. This observation should still increase our confidence and compliance regarding CP for controlling GRE outbreaks.…”