All Journals > Infection Control and Hospital Epidemiology > May 2008 > VRE BSI Among Patients Colonized With VRE

Article Tools

Search for Related Articles

  • By Author
  • Search In

Announcements

HAI Prevention Compendium Now Available - A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals

>>  Go to media kit
>> Order Reprints

Highlighted Article

SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility

 

More than 1.5 million residents reside in United States (US) nursing homes. In recent years, the acuity of illness of nursing home residents has increased, and LTCF residents have a risk of developing HAIs that approaches the number seen in acute care hospital patients. A great deal of information has been published concerning infections in the LTCF, and infection control programs are nearly universal in that setting. This position paper reviews the literature on infections and infection control programs in the LTCF.

>> Read Guideline

In the News

Featured in New York Times
"Infection Control Guidelines Issued" October 8, 2008
A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals
SHEA, IDSA, AHA, APIC and The Joint Commission
Hoping to improve infection control in hospitals, the nation’s top epidemiological societies joined Wednesday with the American Hospital Association and the Joint Commission, which accredits hospitals, to issue a compendium of guidelines for preventing six lethal conditions.

Featured in Time
"Hand Gel Not an Infection Cure-all" January 30, 2008
Prospective, Controlled, Cross-Over Trial of Alcohol-Based Hand Gel in Critical Care Units
Mark E. Rupp, MD; Teresa Fitzgerald, RN; Susan Puumala, MS; James R. Anderson, PhD; Rita Craig, RN; Peter C. Iwen, PhD; Dawn Jourdan, RN; Janet Keuchel, RN; Nedra Marion, RN; Delayne Peterson, PA; Lee Sholtz, RN; Valerie Smith, RN

Doctors and nurses on the go often skip soap and water in favor of an alcohol-based hand gel, thinking the quick-acting goo will kill bacteria on their hands and curb the spread of infection.  It turns out that's not enough.

May 2008

Volume 29, Number 5
Infect Control Hosp Epidemiol 2008;29:404–409
© 2008 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2008/2905-0004$15.00
DOI: 10.1086/587647
Original Article

Risk of Vancomycin-Resistant Enterococcus (VRE) Bloodstream Infection Among Patients Colonized With VRE

Chamion N. Olivier, MD, MSc;

Ruth K. Blake, MT;

Lisa L. Steed, PhD;

Cassandra D. Salgado, MD, MS

From the Medical University of South Carolina, Charleston, South Carolina.

Background.  Colonization with vancomycin-resistant Enterococcus (VRE) is a risk factor for subsequent VRE bloodstream infection (BSI); however, risk factors for BSI among colonized patients have not been adequately described. We sought to determine the proportion of VRE-colonized patients who subsequently develop VRE BSI and to identify risk factors for VRE BSI among these patients.

Methods.  Records of 768 patients colonized with VRE from January 2002 through June 2005 were reviewed. The proportion of patients who developed VRE BSI was calculated, and the characteristics of these patients were compared, in a 2:1 ratio, with those of patients who did not develop VRE BSI. To identify risk factors for VRE BSI and for death, we used univariate logistic regression analysis and then multivariate logistic regression analysis. Using pulsed-field gel electrophoresis (PFGE), we compared the isolate recovered when the patient was colonized and the isolate recovered when the patient developed VRE BSI.

Results.  Of the 768 patients colonized with VRE, 31 (4.0%) developed VRE BSI. Multivariate analysis identified the following idependent risk factors for developing VRE BSI: infection of an additional body site other than blood (adjusted odds ratio [aOR], 3.9; ), admission to the hospital from a long-term care facility (aOR, 12.6; ), and receipt of vancomycin (aOR, 10.6; ). The independent risk factors for death among patients colonized with VRE were immunosuppression (aOR, 12.9; ) and VRE BSI (aOR, 9.1; ). Of the 31 patients who developed VRE BSI, 23 (74%) had a pair of isolates representing VRE colonization and VRE BSI. For 19 (83%) of these 23 patients, the isolate representing BSI was genetically related to the isolate representing VRE colonization: 12 pairs of isolates (52%) had identical banding patterns, 5 had closely related patterns, and 2 had possibly related patterns.

Conclusion.  Of the 768 patients colonized with VRE, 31 (4.0%) usually developed VRE BSI due to a related strain. Independent risk factors for BSI among colonized patients were admission from a long-term care facility, infection of an additional body site, and exposure to vancomycin. Independent risk factors for death were immunosuppression and VRE BSI.

Received November 18, 2007; accepted February 15, 2008; electronically published April 2, 2008.

Address reprint requests to Cassandra D. Salgado, MD, Medical University of South Carolina, 100 Doughty Street, Suite 210 IOP S, Charleston, SC 29425 ().

  • Presented in part: 44th Annual Meeting of the Infectious Diseases Society of America; Toronto, Ontario, Canada; October 12-15, 2006 (Abstract 1028).

Back to Top
Close Popup