title: Identification of temporal clusters and risk factors of bacteremia by nosocomial vancomycin-resistant enterococci.
abstract: BACKGROUND
  This study aimed to evaluate a different methodology for addressing the evolution of nosocomial bacteremia by vancomycin-resistant enterococci (VRE) in a hospital setting.
  
  
  METHODS
  In this retrospective cohort study, data were collected from the date of first registration up to December 2008 from the electronic medical records of patients with VRE bacteremia in a school hospital.
  
  
  RESULTS
  Thirty cases of VRE bacteremia and 274 cases of vancomycin-susceptible enterococci (VSE) bacteremia were identified. The average age of the patients was 56 years. The rates of Enterococcus faecium and Enterococcus faecalis in the hospital's intensive care unit (ICU) and wards showed no statistically significant differences. The risk of acquiring VRE bacteremia was at least 3-fold higher in the ICU than in the wards. The risk of death was 2.73-fold higher in patients with VRE bacteremia compared with those with VSE bacteremia. Only one temporal cluster statistically significant of VRE bacteremia was found in the study period.
  
  
  CONCLUSIONS
  The identification of temporal clusters can be an important tool to optimize health actions and thereby reduce the burden of operating costs.
authors.affiliation: Postgraduate Department, Medical College of São José do Rio Preto, São Paulo, Brazil; Medical Sciences Department, Medical College, Union of Colleges of the Great Lakes, São José do Rio Preto, São Paulo, Brazil. Electronic address: natalss@gmail.com.
authors.forename: Natal Santos
authors.initials: NS
authors.lastname: da Silva
authors.affiliation: Department of Infectious and Parasitic Diseases, Hospital de Base, São José do Rio Preto, São Paulo, Brazil.
authors.forename: Vitor Dantas
authors.initials: VD
authors.lastname: Muniz
authors.affiliation: Department of Infectious and Parasitic Diseases, Hospital de Base, São José do Rio Preto, São Paulo, Brazil; Virology Laboratory, Medical College of São José do Rio Preto, São Paulo, Brazil.
authors.forename: Cássia Fernanda
authors.initials: CF
authors.lastname: Estofolete
authors.affiliation: Hospital Epidemiology Committee, Department of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Guilherme Henrique Campos
authors.initials: GH
authors.lastname: Furtado
authors.affiliation: Department of Infectious and Parasitic Diseases, Hospital de Base, São José do Rio Preto, São Paulo, Brazil.
authors.forename: Fernando Gongora
authors.initials: FG
authors.lastname: Rubio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013293:Enterococcus faecalis / Q000187:drug effects* / Q000302:isolation & purification; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D020713:Vancomycin Resistance; D055815:Young Adult
keywords: Antibiotic; Cohort study; Resistance profile; Sepsis