Risk factors for and epidemiology of community-onset vancomycin-resistant Enterococcus faecalis in southeast Michigan

Omotola, A. M.; Li, Yumeng; Martin, Emily T.; Alshabani, Khaled; Yadav, Divya; Sarkar, Moumita; Thapa, Sudeep Dhoj; Kumar, Vinod; Mahabashya, Anjani; Ahmad, Sufian S.; Bhargava, Ashish; Marchaim, Dror; Pogue, Jason M.; Rybak, Michael J.; Kaye, Keith S.; Hayakawa, Kayoko

doi:10.1016/j.ajic.2013.05.025

Cited by 15 publications

(23 citation statements)

References 19 publications

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“…These identified risk factors are consistent with those identified in studies of both adult and pediatric patients, which include previous invasive procedures and surgery, recent exposure to antibiotics, immunosuppressive status, and presence of indwelling devices. 45,46 In addition to the rise in hospitalizations for VRE, we also showed that VRE infection had a significant impact on the burden of hospitalizations in pediatric patients. Children with VRE had longer hospital stays and higher hospitalization costs than patients without VRE.…”

Section: Discussionmentioning

confidence: 87%

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Adams

Eberly

Goudie

et al. 2016

Hospital Pediatrics

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A B S T R A C T OBJECTIVE:Vancomycin-resistant Enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing numbers of nosocomial infections in adults. Few data are available on the epidemiology and impact of VRE infections in children. We hypothesized a significant increase in VRE infections among hospitalized children. Additionally, we predicted that VRE infection would be associated with certain comorbid conditions and increased duration and cost of hospitalization. METHODS:A retrospective study of inpatient pediatric patients was performed using data on hospitalizations for VRE from the Healthcare Cost and Utilization Project Kids' Inpatient Database from 1997 to 2012. We used a multivariable logistic regression model to establish factors associated with VRE infection and a high-dimensional propensity score match to evaluate death, length of stay, and cost of hospitalization. RESULTS: Hospitalizations for VRE infection showed an increasing trend, from 53 hospitalizationsper million in 1997 to 120 in 2012 (P , .001). Conditions associated with VRE included Clostridium difficile infection and other diagnoses involving immunosuppression and significant antibiotic and health care exposure. Patients with VRE infection had a significantly longer length of stay (attributable difference [AD] 2.1 days, P , .001) and higher hospitalization costs (AD $8233, P 5 .004). VRE infection was not associated with an increased risk of death (odds ratio 1.03; 95% confidence interval 0.73-1.47).CONCLUSIONS: VRE infections among hospitalized children are increasing at a substantial rate. This study demonstrates the significant impact of VRE on the health of pediatric patients and highlights the importance of strict adherence to existing infection control policies and VRE surveillance in certain high-risk pediatric populations.

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Section: Discussionmentioning

confidence: 87%

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Adams

Eberly

Goudie

et al. 2016

Hospital Pediatrics

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“…Five studies used the NHSN definition of hospital-acquired VRE infections [2,15,[21][22][23], 8 studies included patients with VRE recovered from sterile sites [13,16,17,20,25,[27][28][29], 4 studies included patients with VRE recovered from sterile sites or urine [14,18,19,26], and 1 study did not define VRE infection [24]. Overall, the risk of bias among all studies evaluated was low ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen studies were eligible for inclusion including: 5 multicenter studies reporting the incidence of VRE infections [2,[13][14][15][16] and 13 studies (4 multicenter and 9 single center) evaluating relevant outcomes [17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Resultsmentioning

confidence: 99%

“…Four studies assessed LOS attributable to VRE infections by either matching infected patients and uninfected patients on time at risk or by matching on propensity scores. These studies found that LOS for patients with VRE infections was 3 to 4.6 days (median difference) longer [18,19,25] or 1.4 times (multiplicative increase) longer [21], than for uninfected patients.…”

Section: Post-infection Los and Los Attributable To Vrementioning

confidence: 99%

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Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

Chiang

Perencevich

Nair

et al. 2016

Infect. Control Hosp. Epidemiol.

106

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“…The increase of vancomycin-resistant enterococci out-of-hospital VRE [2]. Specific facilities are known as important reservoirs of VRE.…”

Section: Introductionmentioning

confidence: 99%

Steady Inflow of Vancomycin-Resistant Enterococci from Outside a Hospital

Park

et al. 2017

Korean J Healthc Assoc Infect Control Prev

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Background: Cross-transmission within hospitals has been considered a major source of vancomycin-resistant enterococci (VRE) acquisition. Inflow of VRE from outside hospitals may also be an important factor in South Korea. Methods: An active-point surveillance for VRE colonization was performed in one medical ward of a 767-bed hospital using single rectal swabs or stool samples. The proportion of VRE detected within 48 h of admission was sought. Risk factors for VRE acquisition were analyzed. To confirm the persistence of VRE inflow outside a single point, the degree of yearly VRE inflow was assessed by passive surveillance of clinical specimens over 2 years in the hospital, each one year before and after the active surveillance. Results: The active-point surveillance of 9 days resulted in 28 (28/72, 38.9%) VRE-positive patients, of whom nine (9/72, 12.5%) were patients were estimated to originate from outside the hospital. The duration of hospitalization and the use of antibiotics were significant risk factors for VRE colonization after admission, and the number of days from admission to first VRE positivity was a median of 8.5 (interquartile range, 2.7-15.0). During the 2 years, 213 patients were identified to be VRE-positive per clinical specimens with 95.5% of concurrent stool VRE, and 12.6% (27/213) were estimated to have acquired the infection from outside the hospital. This confirmed that the VRE inflow was continuous, but not transient or resembling an outbreak on one point. Conclusion: The inflow of VRE was steady in a tertiary hospital with an average infection control policy in South Korea and should be a further target for VRE control.

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Risk factors for and epidemiology of community-onset vancomycin-resistant Enterococcus faecalis in southeast Michigan

Cited by 15 publications

References 19 publications

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

Steady Inflow of Vancomycin-Resistant Enterococci from Outside a Hospital

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