title: Risk factors for rectal colonization with vancomycin-resistant enterococci in Shiraz, Iran.
abstract: OBJECTIVE
  In order to determine the risk factors for rectal colonization with vancomycin-resistant enterococci (VRE) at the Shiraz Namazi Hospital, we performed a nested case-control study.
  
  
  METHODS
  From December 2003 to July 2004 rectal swabs were taken from 700 randomly selected hospitalized patients every 5 days.
  
  
  RESULTS
  A total of 99 of the 700 patients (14%) were colonized with VRE (cases) and 59 patients were colonized with vancomycin-sensitive strains (VSE), serving as controls. In the univariate analysis, history of antibiotic use (p=0.04), underlying disease (p=0.013), hemodialysis (p=0.03), use of third generation cephalosporins (p=0.04), use of vancomycin (p=0.04), and duration of vancomycin therapy longer than 7 days (p=0.02) were significantly associated with VRE colonization. In a multivariate analysis, underlying disease and the duration of vancomycin use longer than 7 days were independently associated with VRE colonization.
  
  
  CONCLUSIONS
  Our study, the first on VRE carriage in Iran, demonstrates that VRE prevalence is high in Shiraz and confirms earlier observations in other countries. The identified risk factor 'use of vancomycin longer than 7 days' may be avoidable, indicating a feasible intervention strategy in the control of VRE.
authors.affiliation: Department of Community Medicine, Shiraz University of Medical Sciences, PO Box 71345-1737, Shiraz, Iran. askariam@sums.ac.ir
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Askarian
authors.forename: Rahim
authors.initials: R
authors.lastname: Afkhamzadeh
authors.forename: Ahmad
authors.initials: A
authors.lastname: Monabbati
authors.forename: Florian
authors.initials: F
authors.lastname: Daxboeck
authors.forename: Ojan
authors.initials: O
authors.lastname: Assadian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006748:Hospital Departments; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007492:Iran / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012007:Rectum / Q000382:microbiology*; D012307:Risk Factors; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents