Risk factors for rectal colonization with vancomycin-resistant enterococci in Shiraz, Iran.
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.
Askarian
Mehrdad
M
Department of Community Medicine, Shiraz University of Medical Sciences, PO Box 71345-1737, Shiraz, Iran. askariam@sums.ac.ir
Afkhamzadeh
Rahim
R
Monabbati
Ahmad
A
Daxboeck
Florian
F
Assadian
Ojan
O
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
D000900:Anti-Bacterial Agents