Journal Article

Prior Environmental Contamination Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci

Marci Drees, David R. Snydman, Christopher H. Schmid, Laurie Barefoot, Karen Hansjosten, Padade M. Vue, Michael Cronin, Stanley A. Nasraway and Yoav Golan

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 5, pages 678-685
Published in print March 2008 | ISSN: 1058-4838
Published online March 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/527394
Prior Environmental Contamination Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci

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Background. Patients colonized with vancomycin-resistant enterococci (VRE) frequently contaminate their environment, but the environmental role of VRE transmission remains controversial.

Methods. During a 14-month study in 2 intensive care units, weekly environmental and twice-weekly patient surveillance cultures were obtained. VRE acquisition was defined as a positive culture result >48 h after admission. To determine risk factors for VRE acquisition, Cox proportional hazards models using time-dependent covariates for colonization pressure and antibiotic exposure were examined.

Results. Of 1330 intensive care unit admissions, 638 patients were at risk for acquisition, and 50 patients (8%) acquired VRE. Factors associated with VRE acquisition included average colonization pressure (hazard ratio [HR], 1.4 per 10% increase; 95% confidence interval [CI], 1.2–1.8), mean number of antibiotics (HR, 1.7 per additional antibiotic; 95% CI, 1.2–2.5), leukemia (HR, 3.1; 95% CI, 1.2–7.8), a VRE-colonized prior room occupant (HR, 3.1; 95% CI, 1.6–5.8), any VRE-colonized room occupants within the previous 2 weeks (HR, 2.5; 95% CI, 1.3–4.8), and previous positive room culture results (HR, 3.4; 95% CI, 1.2–9.6). In separate multivariable analyses, a VRE-colonized prior room occupant (HR, 3.8; 95% CI, 2.0–7.4), any VRE-colonized room occupants within the previous 2 weeks (HR, 2.7; 95% CI, 1.4–5.3), and previous positive room culture results (HR, 4.4; 95% CI, 1.5–12.8) remained independent predictors of VRE acquisition, adjusted for colonization pressure and antibiotic exposure.

Conclusions. We found that prior room contamination, whether measured via environmental cultures or prior room occupancy by VRE-colonized patients, was highly predictive of VRE acquisition. Increased attention to environmental disinfection is warranted.

Journal Article.  4477 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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