title: Implications for vancomycin-resistant Enterococcus colonization associated with Clostridium difficile infections.
abstract: BACKGROUND
  Vancomycin-resistant Enterococcus (VRE) colonization of the gastrointestinal tract shares similar risk factors with Clostridium difficile infection. We sought to elucidate the prevalence and risk factors of VRE colonization associated with C difficile infection.
  
  
  METHODS
  All adult inpatients with C difficile infection from July 2006 to October 2006 were prospectively evaluated. All C difficile toxin-positive stool samples were screened for detection of VRE. Risk factors for VRE colonization were compared in patients with C difficile infection with and without VRE colonization.
  
  
  RESULTS
  Of the 158 cases of C difficile infection evaluated, 88 (55.7%) involved VRE colonization. Independent risk factors for VRE colonization were admission from long-term care facilities (P = .013), dementia (P = .017), and hospitalization in the previous 2 months (P = .014). No statistically significant difference between C difficile infection cases with and without VRE colonization in terms of previous receipt (within 1 month) of antibiotics, including metronidazole and vancomycin, was found on multivariate analysis. C difficile infection cases with VRE colonization had a higher prevalence of coinfection with methicillin-resistant Staphylococcus aureus (P = .002) and Acinetobacter spp (P = .006).
  
  
  CONCLUSIONS
  VRE colonization was associated with >50% of C difficile infection cases and with a higher rate of coinfection with multidrug-resistant pathogens. Given the high rate of C difficile infection associated with VRE colonization, active surveillance of VRE in patients with C difficile infection is reasonable in high-risk settings.
authors: Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. shigekifujitani@marianna-u.ac.jp
authors: Shigeki
authors: S
authors: Fujitani
authors: W Lance
authors: WL
authors: George
authors: Margie A
authors: MA
authors: Morgan
authors: Stephen
authors: S
authors: Nichols
authors: A Rekha
authors: AR
authors: Murthy
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D016360:Clostridioides difficile / Q000302:isolation & purification*; D016983:Enterococcus / Q000187:drug effects / 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; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D020713:Vancomycin Resistance