Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients.
Vancomycin-resistant enterococci (VRE) are important hospital pathogens and have become increasingly common in patients admitted to the intensive care unit (ICU). To determine the incidence and the risk factors associated with VRE colonisation among ICU patients, active surveillance cultures for VRE faecal carriages were carried out in patients admitted to the ICU of the University Hospital of Uberlândia, Minas Gerais, Brazil. Risk factors were assessed using a case-control study. Seventy-seven patients (23.1%) were found to be colonised with vanC VRE and only one patient (0.3%) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1%) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VRE-colonised patients are a potential epidemiologic reservoir of resistance genes.
Laboratório de Microbiologia, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brasil. deividwfb@yahoo.com.br
Deivid William da Fonseca
DW
Batistão
Paulo Pinto
PP
Gontijo-Filho
Natália
N
Conceição
Adriana Gonçalves de
AG
Oliveira
Rosineide Marques
RM
Ribas
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D016638:Critical Illness; D003428:Cross Infection / Q000382:microbiology*; D016983:Enterococcus / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D012307:Risk Factors; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents