title: Enteric carriage of vancomycin-resistant Enterococcus faecium in patients tested for Clostridium difficile.
abstract: OBJECTIVE
  To identify independent risk factors for enteric carriage of vancomycin-resistant Enterococcus faecium (VREF) in hospitalized patients tested for Clostridium difficile toxin.
  
  
  METHODS
  Retrospective case-cohort study.
  
  
  METHODS
  Tertiary-care teaching hospital.
  
  
  METHODS
  Convenience sample of 215 adult inpatients who had stool tested for C difficile between January 29 and February 25, 1996.
  
  
  RESULTS
  41 (19%) of 215 patients had enteric carriage of VREE Five independent risk factors for enteric VREF were identified: history of prior C difficile (odds ratio [OR], 15.21; 95% confidence interval [CI95], 3.30-70.10; P < .001), parenteral treatment with vancomycin for > or = 5 days (OR, 4.06; CI95, 1.54-10.73; P = .005), treatment with antimicrobials effective against gram-negative organisms (OR, 3.44; CI95, 1.20-9.87; P = .021), admission from another institution (OR, 2.95; CI95, 1.21-7.18; P =.017), and age > 60 years (OR 2.57; CI95, 1.13-5.82; P = .024). These risk factors for enteric VREF were independent of the patient's current C difficile status.
  
  
  CONCLUSIONS
  Antimicrobial exposures are the most important modifiable independent risk factors for enteric carriage of VREF in hospitalized patients tested for C difficile.
authors.affiliation: Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Garbutt
authors.forename: B
authors.initials: B
authors.lastname: Littenberg
authors.forename: B A
authors.initials: BA
authors.lastname: Evanoff
authors.forename: D
authors.initials: D
authors.lastname: Sahm
authors.forename: L M
authors.initials: LM
authors.lastname: Mundy
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology*; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004197:Disease Reservoirs / Q000706:statistics & numerical data; D016984:Enterococcus faecium / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D013223:Statistics as Topic; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents