title: Recovery of both vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus from culture of a single clinical specimen from colonized or infected patients.
abstract: OBJECTIVE
  To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.
  
  
  METHODS
  A retrospective cohort and case-control study.
  
  
  METHODS
  A tertiary care university hospital and referral center in Seoul, Korea.
  
  
  METHODS
  We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2:1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.
  
  
  RESULTS
  The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00; P=.012 ), urinary catheterization (OR, 3.36; P=.026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03; P < .001).
  
  
  CONCLUSIONS
  We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer of vanA, close observation and surveillance for vancomycin-resistant S. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.
authors.affiliation: Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Han
authors.forename: Bum Sik
authors.initials: BS
authors.lastname: Chin
authors.forename: Han Sung
authors.initials: HS
authors.lastname: Lee
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Jeong
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Choi
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Kim
authors.forename: Chang Oh
authors.initials: CO
authors.lastname: Kim
authors.forename: Dongeun
authors.initials: D
authors.lastname: Yong
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
authors.forename: Young Goo
authors.initials: YG
authors.lastname: Song
authors.forename: Kyungwon
authors.initials: K
authors.lastname: Lee
authors.forename: June Myung
authors.initials: JM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D016022:Case-Control Studies; D015331:Cohort Studies; D003470:Culture Media; D016983:Enterococcus / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007723:Korea / Q000453:epidemiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D020713:Vancomycin Resistance
chemical_list: D003470:Culture Media