Investigating the relationship between vancomycin-resistant Enterococcus control practices and the incidence of health care–associated Clostridioides difficile infections in Ontario

Ling, Rebecca; Achonu, Camille; Li, Ye; Katz, Kevin; Garber, Gary; Johnstone, Jennie

doi:10.1016/j.ajic.2019.08.021

American Journal of Infection Control

2020

DOI: 10.1016/j.ajic.2019.08.021

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Investigating the relationship between vancomycin-resistant Enterococcus control practices and the incidence of health care–associated Clostridioides difficile infections in Ontario

Rebecca Ling

Camille Achonu

Ye Li

et al.

Abstract: We evaluated the impact of discontinuing vancomycin-resistant Enterococcus (VRE) screening and use of contact precautions on the incidence of health care−associated Clostridioides difficile infection (HA-CDI) in acute teaching hospitals in Ontario, Canada. Among hospitals that stopped VRE screening and contact precaution measures, there was a significant change in HA-CDI rates after the discontinuation of practices (incidence rate ratios, 1.11; 95% confidence interval, 1.01-1.22). No change in rate was observe… Show more

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2023

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Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study

Meschiari,

Kaleci,

Monte

et al. 2023

Antimicrob Resist Infect Control

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Background Vancomycin-resistant enterococcus (VRE) was the fastest growing pathogen in Europe in 2022 (+ 21%) but its clinical relevance is still unclear. We aim to identify risk factors for acquired VRE rectal colonization in hematological patients and evaluate the clinical impact of VRE colonization on subsequent infection, and 30- and 90-day overall mortality rates, compared to a matched control group. Methods A retrospective, single center, case–control matched study (ratio 1:1) was conducted in a hematological department from January 2017 to December 2020. Case patients with nosocomial isolation of VRE from rectal swab screening (≥ 48 h) were matched to controls by age, sex, ethnicity, and hematologic disease. Univariate and multivariate logistic regression compared risk factors for colonization. Results A total of 83 cases were matched with 83 controls. Risk factors for VRE colonization were febrile neutropenia, bone marrow transplant, central venous catheter, bedsores, reduced mobility, altered bowel habits, cachexia, previous hospitalization and antibiotic treatments before and during hospitalization. VRE bacteraemia and Clostridioides difficile infection (CDI) occurred more frequently among cases without any impact on 30 and 90-days overall mortality. Vancomycin administration and altered bowel habits were the only independent risk factors for VRE colonization at multivariate analysis (OR: 3.53 and 3.1; respectively). Conclusions Antimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for VRE nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between CDI and VRE, which deserves further investigation to target new therapeutic approaches.

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Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study

Meschiari,

Kaleci,

Monte

et al. 2023

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

show abstract

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Investigating the relationship between vancomycin-resistant Enterococcus control practices and the incidence of health care–associated Clostridioides difficile infections in Ontario

Cited by 1 publication

References 7 publications

Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study

Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study

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