title: Factors associated with Vancomycin-resistant Enterococcus acquisition during a large outbreak.
abstract: Between 2013 and 2014 a Vancomycin-resistant Enterococci (VRE) outbreak occurred in a teaching hospital in France. The outbreak was significant possibly due to the lack of implementation of recommended control measures. The aim of this study was to identify the effect of the lack of adherence to control measures for prevention of VRE acquisition in contact patients taking into account individual risk factors. Contact patients (first two months of the outbreak) with VRE acquisition were compared to patients without VRE acquisition (univariate and logistic regression), in terms of institutional characteristics (unit of hospitalization and isolation measures) and risk factors. Between December 2013 and February 2014, 282 contact patients were included in the study. The prevalence of VRE acquisition was 6.4% (18/282). Significant risk factors for VRE acquisition according to logistic regression analysis were; lack of isolation, hospitalization in the same hospital unit as a VRE carrier patient and lack of isolation (RR=856.8, p=0.001), hospitalization in a specific unit (RR=927.4, p=0.002), McCabe score equal to 2 (RR=5233.6, p=0.008), age (RR=1.2 by year, p=0.011), hemodialysis (RR=36.1, p=0.011), central venous catheter (RR=25.4, p=0.021) and surgery (RR=0.012, p=0.007). Antibiotic use was a significant risk factor for VRE acquisition using univariate analysis (p<10-3). The findings confirm that the factors focused on by the study (lack of isolation and dedicated unit) had a significant effect on VRE acquisition as patient associated factors. It highlights the importance of observance of the guidelines.
authors.affiliation: Epidemiology and Hygiene Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
authors.forename: Larissa
authors.initials: L
authors.lastname: Fossi Djembi
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hodille
authors.affiliation: Epidemiology and Hygiene Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Chomat-Jaboulay
authors.affiliation: Epidemiology and Hygiene Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Coudrais
authors.affiliation: Epidemiology and Hygiene Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: De Santis
authors.affiliation: Epidemiology and Hygiene Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Gardes
authors.affiliation: Epidemiology and Hygiene Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
authors.forename: Catherine Cécile
authors.initials: CC
authors.lastname: Mauranne
authors.affiliation: Epidemiology and Hygiene Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mourey
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fredenucci
authors.affiliation: Epidemiology and Hygiene Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France. Electronic address: raphaele.girard@chu-lyon.fr.
authors.forename: Raphaële
authors.initials: R
authors.lastname: Girard
mesh_terms: D000368:Aged; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D005602:France / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*
keywords: Colonization; Emerging pathogen; Outbreak; Vancomycin-resistant Enterococcus