Risk factors for vancomycin-resistant Enterococcus colonization in hematologic patients.
OBJECTIVE
Vancomycin-resistant Enterococci (VRE) is one of the most important hospital pathogens. The aim of the study was to evaluate VRE colonization in patients hospitalized at the Hematology Intensive Care Unit, as well as the associated risk factors.


METHODS
A prospective cohort study involved 70 patients hospitalized at the Intensive Care Unit (ICU), Clinic for Hematology, Clinical Center of Serbia, Belgrade, during 3 months. Baseline demographic data, data about antibiotic usage and other risk factors for VRE colonization during the present and previous hospitalizations (within 6 months) were recorded for each patient using the questionnaire. Feces or rectal swab was collected for culture from patients on admission and at discharge in case when VRE was not isolated on admission. Enterococci were isolated by standard microbiological methods. Isolate sensitivity was tested by disk-diffusion test using 30 microg/mL (BBL) Vancomycin plates according to the Clinical and Laboratory Standards Institute (CLSI) standard.


RESULTS
Analysing results showed that 7% of the patients had been already colonized with VRE upon ICU admission. The rate of VRE colonization during present hospitalization was 41.5%. Univariate logistic regression demonstrated the statistically significant differences in diagnosis, length of present stay, use of aminoglycosides and piperacillin/tazobactam in present hospitalization, duration of use of carbapenem and piperacillin/tazobactam in present hospitalization between the VRE-colonized and non-colonized patients. Acute myeloid leukemia (AML), use of carbapenem in previous hospitalization and duration of use of piperacillin/tazobactam in present hospitalization were independent risk factors for VRE-colonized patients according to multivariate logistic regression.


CONCLUSIONS
VRE colonization rate was high among the patients admitted to hematology ICU. Rational use of antibiotics and active surveillance may be helpful preventive measures against the development of bacterial resistance to antimicrobial agents.
Department of Hospital Epidemiology and Hygiene, Clinical Center of Serbia, Belgrade, Serbia. vesna.mioljevic@gmail.com
Vesna
V
Mioljević
Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Ljiljana
L
Marković-Denić
Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.
Ana
A
Vidović
Microbiology Department, Clinical Center of Serbia, Belgrade, Serbia.
Milica
M
Jovanović
Microbiology Department, Clinical Center of Serbia, Belgrade, Serbia.
Tanja
T
Tosić
Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.
Dragica
D
Tomin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000382:microbiology*; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000209:etiology*; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020713:Vancomycin Resistance; D055815:Young Adult
D000900:Anti-Bacterial Agents