Journal
AMERICAN JOURNAL OF INFECTION CONTROL
Volume 41, Issue 12, Pages 1244-1248Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.ajic.2013.05.025
Keywords
Vancomycin-resistant Enterococcus; Enterococcus faecalis; Vancomycin-resistant Staphylococcus aureus
Funding
- National Institute of Allergy and Infectious Diseases (DMID) [10-0065]
- National Institute of Allergy and Infectious Diseases [R21AI092055]
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Background: Given the known link between vancomycin-resistant Enterococcus faecalis (VREF) and vancomycin-resistant Staphylococcus aureus (VRSA), the recent increase in prevalence of VREF in southeast Michigan has raised concerns about the presence of a large community reservoir of VREF. Efforts to control its spread face some important challenges. Methods: Patients with clinical isolates of community-onset (CO) VREF (cases) were compared with matched uninfected controls (study 1) and patients with hospital-onset (HO) VREF (study 2). Here, CO was defined as a hospital stay of <= 2 days before VRE isolation. Results: Independent predictors for the isolation of CO-VREF compared with uninfected controls were nonhome residence; chronic skin ulcers; previous invasive procedures/surgery; exposure to cephalosporin, penicillin, and/or vancomycin; immunosuppressive status; and the presence of indwelling devices. Independent predictors for isolation of CO-VREF compared with HO-VREF included no stay in an intensive care unit in the previous 3 months and recent hospitalization. VREF isolation from wounds and aminoglycoside exposure were inversely associated with isolation of CO-VREF. Conclusions: Health care-related exposures and antimicrobial exposures are risk factors for the isolation of CO-VREF. Regional infection control practices are imperative in controlling CO-VREF, in addition to the emergence and spread of VRSA. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
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