title: Risk factors for and epidemiology of community-onset vancomycin-resistant Enterococcus faecalis in southeast Michigan.
abstract: BACKGROUND
  Given the known link between vancomycin-resistant Enterococcus faecalis (VREF) and vancomycin-resistant Staphylococcus aureus (VRSA), the recent increase in prevalence of VREF in southeast Michigan has raised concerns about the presence of a large "community" reservoir of VREF. Efforts to control its spread face some important challenges.
  
  
  METHODS
  Patients with clinical isolates of community-onset (CO) VREF (cases) were compared with matched uninfected controls (study 1) and patients with hospital-onset (HO) VREF (study 2). Here, CO was defined as a hospital stay of ≤2 days before VRE isolation.
  
  
  RESULTS
  Independent predictors for the isolation of CO-VREF compared with uninfected controls were nonhome residence; chronic skin ulcers; previous invasive procedures/surgery; exposure to cephalosporin, penicillin, and/or vancomycin; immunosuppressive status; and the presence of indwelling devices. Independent predictors for isolation of CO-VREF compared with HO-VREF included no stay in an intensive care unit in the previous 3 months and recent hospitalization. VREF isolation from wounds and aminoglycoside exposure were inversely associated with isolation of CO-VREF.
  
  
  CONCLUSIONS
  Health care-related exposures and antimicrobial exposures are risk factors for the isolation of CO-VREF. Regional infection control practices are imperative in controlling CO-VREF, in addition to the emergence and spread of VRSA.
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
authors.forename: Adedayo Morenike
authors.initials: AM
authors.lastname: Omotola
authors.forename: Yumeng
authors.initials: Y
authors.lastname: Li
authors.forename: Emily T
authors.initials: ET
authors.lastname: Martin
authors.forename: Khaled
authors.initials: K
authors.lastname: Alshabani
authors.forename: Divya
authors.initials: D
authors.lastname: Yadav
authors.forename: Moumita
authors.initials: M
authors.lastname: Sarkar
authors.forename: Sudeep Dhoj
authors.initials: SD
authors.lastname: Thapa
authors.forename: Vinod
authors.initials: V
authors.lastname: Kumar
authors.forename: Anjani
authors.initials: A
authors.lastname: Mahabashya
authors.forename: Sufian
authors.initials: S
authors.lastname: Ahmad
authors.forename: Ashish
authors.initials: A
authors.lastname: Bhargava
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rybak
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.forename: Kayoko
authors.initials: K
authors.lastname: Hayakawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D013293:Enterococcus faecalis / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020713:Vancomycin Resistance
keywords: Enterococcus faecalis; Vancomycin-resistant Enterococcus; Vancomycin-resistant Staphylococcus aureus