Prevalence and risk factors of colonisation with vancomycin-resistant Enterococci faecium upon admission to Germany’s largest university hospital

Bui, Minh Trang; Rohde, Anna M.; Schwab, Frank J.; Märtin, Nayana; Kipnis, Marina; Boldt, Anne-Cathérine; Behnke, Michael; Denkel, Luisa A.; Kola, Axel; Zweigner, Janine; Gastmeier, Petra; Wiese-Posselt, Miriam

doi:10.3205/dgkh000377

Cited by 9 publications

(7 citation statements)

References 34 publications

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“…[ 54 ] Cohort 2014–2015 1 tertiary care hospital Hematology-oncology Rectal Colonization E. faecium 1606 patients Patients: 111 prevalence: 23.8% vanB (91%), vanA (9%) Bui et al . [ 55 ] Cross-sectional 2014–2015 1 university hospital Wards (exc. ICU) Rectal Colonization E. faecium 4013 patients Patients: 48. prevalence: 1.2% ND Xanthopoulou et al .…”

Section: Resultsmentioning

confidence: 99%

Vancomycin-resistant enterococci (VRE) in hospital settings across European borders: a scoping review comparing the epidemiology in the Netherlands and Germany

Cimen

Berends

Bathoorn

et al. 2023

Antimicrob Resist Infect Control

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The rising prevalence of vancomycin-resistant enterococci (VRE) is a matter of concern in hospital settings across Europe without a distinct geographical pattern. In this scoping review, we compared the epidemiology of vancomycin-resistant Enterococcus spp. in hospitals in the Netherlands and Germany, between 1991 and 2022. We searched PubMed and summarized the national antibiotic resistance surveillance data of the two countries. We included 46 studies and summarized national surveillance data from the NethMap in the Netherlands, the National Antimicrobial Resistance Surveillance database in Germany, and the EARS-Net data. In total, 12 studies were conducted in hospitals in the Netherlands, 32 were conducted in German hospitals, and an additional two studies were conducted in a cross-border setting. The most significant difference between the two countries was that studies in Germany showed an increasing trend in the prevalence of VRE in hospitals, and no such trend was observed in studies in the Netherlands. Furthermore, in both Dutch and German hospitals, it has been revealed that the molecular epidemiology of VREfm has shifted from a predominance of vanA towards vanB over the years. According to national surveillance reports, vancomycin resistance in Enterococcus faecium clinical isolates fluctuates below 1% in Dutch hospitals, whereas it follows an increasing trend in German hospitals (above 20%), as supported by individual studies. This review demonstrates that VRE is more frequently encountered in German than in Dutch hospitals and discusses the underlying factors for the difference in VRE occurrence in these two neighboring countries by comparing differences in healthcare systems, infection prevention control (IPC) guidelines, and antibiotic use in the Netherlands and Germany.

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Section: Resultsmentioning

confidence: 99%

Vancomycin-resistant enterococci (VRE) in hospital settings across European borders: a scoping review comparing the epidemiology in the Netherlands and Germany

Cimen

Berends

Bathoorn

et al. 2023

Antimicrob Resist Infect Control

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“…Previous antibiotic therapy was associated with an increased risk of VRE colonisation in a number of previous studies [ 2 , 4 , 15 , 18 – 22 ]. The present study clearly corroborates these findings by showing that a previous antibiotic therapy was a significant independent risk factor in the multivariate analysis after taking into account the length of stay as a confounder (OR 1.069, 95% CI 1.037–1.102).…”

Section: Discussionmentioning

confidence: 99%

Previous antibiotic therapy as independent risk factor for the presence of vancomycin-resistant enterococci in surgical inpatients. Results from a matched case-control study

et al. 2023

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Background Investigation of risk factors for the presence of vancomycin-resistant enterococci (VRE) in inpatients on surgical wards and associated intensive care units of a German tertiary care hospital. Methods A single-centre retrospective matched case-control study was performed with surgical inpatients admitted between July 2013 and December 2016. Patients with in-hospital detection of VRE later than 48 h after admission were included and comprised 116 VRE-positive cases and 116 VRE-negative matched controls. VRE isolates of cases were typed by multi-locus sequence typing. Results ST117 was identified as the dominant VRE sequence type. Next to length of stay in hospital or on an intensive care unit and previous dialysis the case-control study revealed previous antibiotic therapy as a risk factor for the in-hospital detection of VRE. The antibiotics piperacillin/tazobactam, meropenem, and vancomycin were associated with the highest risks. After taking into account length of stay in hospital as possible confounder other potential contact-related risk factors such as previous sonography, radiology, central venous catheter, and endoscopy were not significant. Conclusions Previous dialysis and previous antibiotic therapy were identified as independent risk factors for the presence of VRE in surgical inpatients.

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“…Notably, the prevalence of VRE is higher in studies that used active VRE screening approaches. In a study from another German university hospital (2014/15), the VRE colonization prevalence on admission was 1.2% using a cultural screening approach [ 23 ]. A Greek study from 2018 found a VRE point prevalence of 13% among inpatients in a tertiary care hospital who were screened with selective culture media [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and infection control of vancomycin-resistant enterococci at a German university hospital: A three-year retrospective cohort study

Jochim-Vukosavic,

Schwab,

Knegendorf

et al. 2024

PLoS ONE

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Vancomycin-resistant enterococci (VRE) occur in hospitalized patients, causing both infection and colonization. In recent years, there has been an increase in VRE in German and other hospitals, raising the question of how to control this epidemic best. To better understand the specific epidemiology and to guide infection control, we conducted a retrospective cohort study analyzing all patients with VRE at Hannover Medical School, a tertiary university clinic in Germany that specializes in solid organ transplantation. Epidemiologic and clinical characteristics of patients with VRE from 2015–2017 were collected. Basic epidemiologic parameters, including VRE incidence and incidence density, were calculated. Independent risk factors for nosocomial VRE infection compared to colonization were assessed using a logistic regression model. There were 1,492 VRE cases corresponding to 822 individual patients. The incidence was 0.8 VRE cases per 100 cases. A total of 536 (35.9%) of the 1,492 VRE cases were acquired nosocomially. Of the 1,492 cases, 912 cases had VRE-positive samples (894 Enterococcus (E.) faecium and 18 E. faecalis) in our hospital laboratory and the remaining cases were known VRE carriers. The vanB-phenotype was observed in 369 of the 894 (41.3%) E. faecium isolates and in 6 of the 18 (33.3%) E. faecalis isolates. There was an increase over time in the vanB-phenotype proportion in E. faecium (2015: 63 of 171, 36.8%, 2016: 115 of 322, 35.7% and 2017: 191 of 401, 47.6%). A total of 107 cases had a VRE infection (7.2% of all VRE cases) according to the criteria of the German National Reference Center for Surveillance of Nosocomial Infections. The remaining cases were only colonized. Among other factors, leukocytopenia (<1,000/μL), the use of a central venous catheter and the visceral surgery medical specialty were independently associated with nosocomial VRE infection. VRE imposed a relevant and increasing infection control burden at our hospital. Nosocomial VRE infection was predominantly found in certain medical specialties, such as hematology and oncology and visceral surgery. Infection control efforts should focus on these highly affected patient groups/specialties.

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Prevalence and risk factors of colonisation with vancomycin-resistant Enterococci faecium upon admission to Germany’s largest university hospital

Cited by 9 publications

References 34 publications

Vancomycin-resistant enterococci (VRE) in hospital settings across European borders: a scoping review comparing the epidemiology in the Netherlands and Germany

Vancomycin-resistant enterococci (VRE) in hospital settings across European borders: a scoping review comparing the epidemiology in the Netherlands and Germany

Previous antibiotic therapy as independent risk factor for the presence of vancomycin-resistant enterococci in surgical inpatients. Results from a matched case-control study

Epidemiology and infection control of vancomycin-resistant enterococci at a German university hospital: A three-year retrospective cohort study

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