Gastrointestinal Carriage of Vancomycin-Resistant Enterococci and Carbapenem-Resistant Gram-Negative Bacteria in an Endemic Setting: Prevalence, Risk Factors, and Outcomes

Abstract

Background: Gastrointestinal carriage of vancomycin-resistant enterococci (VRE) and carbapenem-resistant Gram-negative bacteria (CRGN) constitutes a major public health concern as it may be followed by clinical infection development or lead to intra-hospital dissemination. Detection of carriers and implementation of infection control measures are essential in every hospital. In this study we determined the point prevalence of VRE and CRGN in the fecal flora of the inpatients of a tertiary university hospital in Greece. We determined risk factors for carriage and examined the impact of carriage on hospital outcomes. Materials/Methods: A point prevalence study of VRE/CRGN rectal carriage of inpatients was conducted on March 2018. Specimens were selectively cultured for VRE/CRGN, microorganisms were biochemically identified, submitted to antibiotic susceptibility testing, and tested for carbapenemase production. Data on potential risk factors and hospital outcomes were collected at the time of culture and until hospital discharge. Multivariable logistic and linear regression models were used, adjusting for confounders.Results: Four hundred ninety-one patients were enrolled in the study. Of them, 64 (13.0%) were positive for VRE carriage, 40 (8.2%) for CRGN, and 10 patients (2.1%) for both VRE and CRGN. VRE carriage was independently associated with age over 65 years (adjusted OR: 2.4 [95%CI: 1.3, 4.5]) and length of stay (LOS) before rectal sampling (OR: 1.1 [95%CI: 1.0, 1.1]). Carriage of CRGN was associated with 11 days increase of LOS after rectal sampling (β-coef: 11.4 [95%CI: 1.6, 21.2]), with a 3.5-fold increased risk of acquiring a resistant pathogen after rectal swabbing (RR: 3.5 [95%CI 1.2, 9.9]) and with a 6-fold increased risk of mortality (RR: 6.1 [95%CI: 2.1, 17.9]), after adjusting for sex, age, and comorbidity index. Vasilakopoulou et al. Gastrointestinal Carriage: Prevalence, Risk-Factors, Outcomes Conclusions: High prevalence rates were found for VRE and CRGN carriage among the inpatients of our hospital. Prolonged hospitalization and age were independent risk factors for VRE carriage, while CRGN carriage was associated with increased risk of acquiring a resistant pathogen, prolonged hospital stay, and increased mortality.

Fecal Microbiota Transplantation: Screening and Selection to Choose the Optimal Donor

“…Enteric pathogens, which must also be investigated in asymptomatic subjects, should be detected with conventional methods (culture, microscopy, or antigen test) and/or with molecular diagnosis (PCR-based panels) that have shown a high specificity and sensitivity compared to conventional methods in rapid detection of pathogens [ 60 ]. Furthermore, it is mandatory to test all fecal samples for antibiotic-resistant bacteria (including meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum β-lactamase-producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae/carbapenemase-producing Enterobacteriaceae), considering the burden of the gastrointestinal carriage in asymptomatic subjects [ 61 , 62 ] and the reporting of some serious adverse events associated to sepsis after FMT [ 13 ]. Nowadays, due to the emerging Covid-19 pandemic, a panel of international experts has suggested to include in the tests for Sars-CoV-2 a thorough nasopharyngeal swab and/or RNA detection in stool [ 63 ].…”

Presence of multidrug resistance (MDR) and extended-spectrum beta-lactamase (ESBL) of Escherichia coli isolated from cloacal swab of broilers in several wet markets in Surabaya, Indonesia

“…The selection of appropriate antibiotics based on bacterial resistance patterns is important for the assessment of bacterial resistance factors and controlling the incidence of resistance from bacteria in animal food to humans (Putra et al 2019;Vasilakopoulou et al 2020). Aztreonam, Gentamicin, Chloramphenicol, Tetracycline, and Ciprofloxacin are broad-spectrum antibiotics from several classes of effective antibiotics and are often used in cases of E. coli bacterial infections (Karaman 2015).…”

Molecular Characterization of New Delhi Metallo-ß-Lactamases-Producing Bacteria in the Gastrointestinal Tract of Intensive Care Unit Patients

“…Our study is in accordance with these findings. However, some studies reported a low level of CRO, even up to 0.5% [ 3 , 11 , 12 ]. The markedly high degree of resistance of gut colonizers to carbapenem in this study can be attributed to geographical variation, different profiles of antibiotic consumption, and the difference in the predominance of bacteria isolated.…”

“…Many studies have shown that the use of invasive devices, three or more classes of antibiotics, hospitalization during the previous six months, comorbidities, and hospital stay for ≥48 h were significantly associated with the development of CRO carriage [ 5 , 9 , 11 , 12 ]. While the use of multiple antibiotics causes selection pressure, invasive devices, and comorbid conditions lead to prolonged hospitalization resulting in the gastrointestinal carriage of CRO [ 11 , 12 ]. Though some studies reported the age of patients as being a risk factor, we did not find this result [ 5 ].…”