title: Small hospitals matter: insights from the emergence and spread of vancomycin-resistant enterococci in 2 public hospitals in inner Brazil.
abstract: Although vancomycin-resistant enterococci (VRE) are reported in Brazil since 1996, data on their impact over settings of different complexity are scarce. We performed a study aimed at identifying determinants of VRE emergence and spread in a public hospital consortium (comprising 2 hospitals, with 318 and 57 beds) in inner Brazil. Molecular typing and case-control studies (addressing predictors of acquisition or clonality) were performed. Among 122 authocthonous isolates, 106 were Enterococcus faecium (22 clones), and 16, Enterococcus faecalis (5 clones). Incidence was greater in the small-sized hospital, and a previous admission to this hospital was associated with greater risk of VRE colonization or infection during admission to the larger one. Overall risk factors included comorbidities, procedures, and antimicrobials (piperacillin-tazobactam, cefepime, and imipenem). Risk factors varied among different hospitals, species, and clones. Our findings demonstrate that VRE can spread within low-complexity facilities and from these to larger hospitals.
authors.affiliation: Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, UNESP-Univ Estadual Paulista, City of Botucatu, São Paulo State, Brazil; Hospital Estadual Bauru, Secretaria de Estado da Saúde de São Paulo, City of Bauru, São Paulo State, Brazil.
authors.forename: Adriana Aparecida Feltrin
authors.initials: AA
authors.lastname: Correa
authors.affiliation: Laboratório Especial de Microbiologia Clínica (LEMC), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), City of São Paulo, São Paulo State, Brazil.
authors.forename: Antonio Carlos Campos
authors.initials: AC
authors.lastname: Pignatari
authors.affiliation: Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, UNESP-Univ Estadual Paulista, City of Botucatu, São Paulo State, Brazil; Hospital Estadual Bauru, Secretaria de Estado da Saúde de São Paulo, City of Bauru, São Paulo State, Brazil.
authors.forename: Monica
authors.initials: M
authors.lastname: da Silveira
authors.affiliation: Laboratório Especial de Microbiologia Clínica (LEMC), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), City of São Paulo, São Paulo State, Brazil.
authors.forename: Roberta Cristina Cabral
authors.initials: RC
authors.lastname: Mingone
authors.affiliation: Laboratório Especial de Microbiologia Clínica (LEMC), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), City of São Paulo, São Paulo State, Brazil.
authors.forename: Vinicius Gomes
authors.initials: VG
authors.lastname: de Sales Oliveira
authors.affiliation: Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, UNESP-Univ Estadual Paulista, City of Botucatu, São Paulo State, Brazil. Electronic address: cmfortaleza@uol.com.br.
authors.forename: Carlos Magno Castelo Branco
authors.initials: CM
authors.lastname: Fortaleza
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D013293:Enterococcus faecalis / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D016984:Enterococcus faecium / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006779:Hospitals, Public; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D012307:Risk Factors; D065507:Vancomycin-Resistant Enterococci / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*
keywords: Case-control; Epidemiology; Pulsed-field gel electrophoresis; Vancomycin-resistant enterococci