Occurrence of co-colonization or co-infection with vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus in a medical intensive care unit.
OBJECTIVE
To determine the occurrence of co-colonization or co-infection with VRE and MRSA among medical patients requiring intensive care.


METHODS
Prospective, single-center, observational study.


METHODS
A 19-bed medical ICU in an urban teaching hospital.


METHODS
Adult patients requiring at least 48 hours of intensive care and having at least one culture performed for microbiologic evaluation.


RESULTS
Eight hundred seventy-eight consecutive patients were evaluated. Of these patients, 402 (45.8%) did not have microbiologic evidence of colonization or infection with either VRE or MRSA, 355 (40.4%) were colonized or infected with VRE, 38 (4.3%) were colonized or infected with MRSA, and 83 (9.5%) had co-colonization or co-infection with VRE and MRSA. Multiple logistic regression analysis demonstrated that increasing age, hospitalization during the preceding 6 months, and admission to a long-term-care facility were independently associated with colonization or infection due to VRE and co-colonization or co-infection with VRE and MRSA. The distributions of positive culture sites for VRE (stool, 86.7%; blood, 6.5%; urine, 4.8%; soft tissue or wound, 2.0%) and for MRSA (respiratory secretions, 34.1%; blood, 32.6%; urine, 17.1%; soft tissue or wound, 16.2%) were statistically different (P < .001).


CONCLUSIONS
Co-colonization or co-infection with VRE and MRSA is common among medical patients requiring intensive care. The recent emergence of vancomycin-resistant Staphylococcus aureus and the presence of a patient population co-colonized or co-infected with VRE and MRSA support the need for aggressive infection control measures in the ICU.
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
David K
DK
Warren
Anand
A
Nitin
Cheri
C
Hill
Victoria J
VJ
Fraser
Marin H
MH
Kollef
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000150:complications / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000382:microbiology; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D008923:Missouri; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D020713:Vancomycin Resistance