Regional dissemination of vancomycin-resistant enterococci resulting from interfacility transfer of colonized patients.
During early 1997, the Siouxland District Health Department (SDHD; Sioux City, IA) reported an increased incidence of vancomycin-resistant enterococcal (VRE) isolates at area health care facilities. To determine the prevalence and risk factors for colonization with VRE strains at 32 health care facilities in the SDHD region, a prevalence survey and case-control study were performed. Of 2266 patients and residents, 1934 (85%) participated, and 40 (2.1%) were positive for (gastrointestinal) VRE colonization. The prevalence of VRE isolates was significantly higher in acute care facilities (ACFs) than in long-term care facilities (LTCFs) (10/152 [6.6%] vs. 30/1782 [1.7%]; odds ratio [OR], 4.1; 95% confidence interval [CI], 1.8-9.0). LTCF case patients were significantly more likely than controls to have been inpatients at any ACF (19/30 vs. 12/66; OR, 8.0; 95% CI, 2.7-23.8). Of 40 VRE isolates, 34 (85%) were a related strain. The predominant strain was present in all 12 LTCFs that had at least 1 case patient in each facility. Soon after the introduction of VRE isolates into this region, dissemination to multiple LTCFs resulted from resident transfer from ACFs to LTCFs.
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Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. wbt9@cdc.gov
Kuehnert
M J
MJ
Quirk
S B
SB
Arduino
M J
MJ
Aguero
S M
SM
Carson
L A
LA
Hill
B C
BC
Banerjee
S N
SN
Jarvis
W R
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D003428:Cross Infection; D004064:Digestive System / Q000382:microbiology; D004352:Drug Resistance, Microbial; D016984:Enterococcus faecium / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D006764:Hospitals, Community; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D015995:Prevalence; D014640:Vancomycin / Q000494:pharmacology*
D000900:Anti-Bacterial Agents; D014640:Vancomycin