title: Case-case-control study on factors associated with vanB vancomycin-resistant and vancomycin-susceptible enterococcal bacteraemia.
abstract: BACKGROUND
  Enterococci are a major cause of healthcare-associated infection. In Australia, vanB vancomycin-resistant enterococci (VRE) is the predominant genotype. There are limited data on the factors linked to vanB VRE bacteraemia. This study aimed to identify factors associated with vanB VRE bacteraemia, and compare them with those for vancomycin-susceptible enterococci (VSE) bacteraemia.
  
  
  METHODS
  A case-case-control study was performed in two tertiary public hospitals in Victoria, Australia. VRE and VSE bacteraemia cases were compared with controls without evidence of enterococcal bacteraemia, but may have had infections due to other pathogens.
  
  
  RESULTS
  All VRE isolates had vanB genotype. Factors associated with vanB VRE bacteraemia were urinary catheter use within the last 30 days (OR 2.86, 95% CI 1.09-7.53), an increase in duration of metronidazole therapy (OR 1.65, 95% CI 1.17-2.33), and a higher Chronic Disease Score specific for VRE (OR 1.70, 95% CI 1.05-2.77). Factors linked to VSE bacteraemia were a history of gastrointestinal disease (OR 2.29, 95% CI 1.05-4.99) and an increase in duration of metronidazole therapy (OR 1.23, 95% CI 1.02-1.48). Admission into the haematology/oncology unit was associated with lower odds of VSE bacteraemia (OR 0.08, 95% CI 0.01-0.74).
  
  
  CONCLUSIONS
  This is the largest case-case-control study involving vanB VRE bacteraemia. Factors associated with the development of vanB VRE bacteraemia were different to those of VSE bacteraemia.
authors: Agnes Loo Yee
authors: AL
authors: Cheah
authors: Trisha
authors: T
authors: Peel
authors: Benjamin P
authors: BP
authors: Howden
authors: Denis
authors: D
authors: Spelman
authors: M Lindsay
authors: ML
authors: Grayson
authors: Roger L
authors: RL
authors: Nation
authors: Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Victoria, Australia. david.kong@monash.edu.
authors: David C M
authors: DC
authors: Kong
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D016983:Enterococcus / Q000472:pathogenicity; D005260:Female; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020713:Vancomycin Resistance; D065507:Vancomycin-Resistant Enterococci / Q000472:pathogenicity; D014739:Victoria