Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
권호 표지
DOI QR코드

DOI QR Code

Factors Associated with Vancomycin-Resistant Enterococcus Colonization in Patients Transferred to Emergency Departments in Korea

  • Kim, Hyun Soon (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Dae Hee (Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yoon, Hai-jeon (Department of Nuclear Medicine, Ewha Womans University School of Medicine) ;
  • Lee, Woon Jeong (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Woo, Seon Hee (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea) ;
  • Choi, Seung Pill (Department of Emergency Medicine, College of Medicine, The Catholic University of Korea)
  • Received : 2018.06.11
  • Accepted : 2018.08.16
  • Published : 2018.11.29
⟨ Previous Next ⟩

Abstract

Background: Vancomycin-resistant enterococci (VRE) infections have become a major healthcare-associated pathogen problem worldwide. Nosocomial VRE infections could be effectively controlled by screening patients at high risk of harboring VRE and thereby lowering the influx of VRE into healthcare centers. In this study, we evaluated factors associated with VRE colonization in patients transferred to emergency departments, to detect patients at risk for VRE carriage. Methods: This study was conducted in the emergency department of a medical college-affiliated hospital in Korea. Every patient transferred to the emergency department and admitted to the hospital from January to December 2016 was screened for VRE using rectal cultures. In this cross-sectional study, the dependent variable was VRE colonization and the independent variables were demographic and clinical factors of the patients and factors related to the transferring hospital. Patients were divided into two groups, VRE and non-VRE, and previously collected patient data were analyzed. Then we performed logistic regression analyses of characteristics that differed significantly between groups. Results: Out of 650 patients, 106 (16.3%) had positive VRE culture results. Significant variables in the logistic analysis were transfer from geriatric long-term care hospital (adjusted odds ration [aOR]: 8.017; 95% confidence interval [CI]: 1.378-46.651), hospital days (4-7 days; aOR: 7.246; 95% CI: 3.229-16.261), duration of antimicrobial exposure (1-3 days; aOR: 1.976; 95% CI: 1.137-3.436), and age (aOR: 1.025; 95% CI: 1.007-1.043). Conclusion: VRE colonization in patients transferred to the emergency department is associated primarily with factors related to the transferred hospitals rather than demographic and clinical characteristics.

Keywords

Acknowledgement

Supported by : The Catholic University of Korea Incheon St. Mary's Hospital

References

  1. van Schaik W, Willems RJ. Genome-based insights into the evolution of enterococci. Clin Microbiol Infect 2010;16(6):527-32. https://doi.org/10.1111/j.1469-0691.2010.03201.x
  2. Lebreton F, Willems RJ, Gilmore MS. Enterococcus diversity, origins in nature, and gut colonization. Enterococci: from commensals to leading causes of drug resistant infection. Boston, MA: Massachusetts Eye and Ear Infirmary; 2014. https://www.ncbi.nlm.nih.gov/books/NBK190427/. Updated 2014. Accessed October 17, 2018.
  3. Fisher K, Phillips C. The ecology, epidemiology and virulence of Enterococcus. Microbiology 2009;155(Pt 6):1749-57. https://doi.org/10.1099/mic.0.026385-0
  4. Lebreton F, van Schaik W, McGuire AM, Godfrey P, Griggs A, Mazumdar V, et al. Emergence of epidemic multidrug-resistant Enterococcus faecium from animal and commensal strains. MBio 2013;4(4):e00534-13.
  5. Zirakzadeh A, Patel R. Vancomycin-resistant enterococci: colonization, infection, detection, and treatment. Mayo Clin Proc 2006;81(4):529-36. https://doi.org/10.4065/81.4.529
  6. Ahmed MO, Baptiste KE. Vancomycin-resistant enterococci: a review of antimicrobial resistance mechanisms and perspectives of human and animal health. Microb Drug Resist 2018;24(5):590-606. https://doi.org/10.1089/mdr.2017.0147
  7. Leclercq R, Derlot E, Duval J, Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988;319(3):157-61. https://doi.org/10.1056/NEJM198807213190307
  8. Favero MS, Gaynes RP, Jarvis WR, Shaw J, Tablan OC, Tenover FC. Recommendations for preventing the spread of vancomycin resistance; recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1995;44(RR-12):1-13.
  9. Tacconelli E, Karchmer AW, Yokoe D, D'Agata EM. Preventing the influx of vancomycin-resistant enterococci into health care institutions, by use of a simple validated prediction rule. Clin Infect Dis 2004;39(7):964-70. https://doi.org/10.1086/423961
  10. Yoon YK, Kim HJ, Lee WJ, Lee SE, Yang KS, Park DW, et al. Clinical prediction rule for identifying patients with vancomycin-resistant enterococci (VRE) at the time of admission to the intensive care unit in a low VRE prevalence setting. J Antimicrob Chemother 2012;67(12):2963-9. https://doi.org/10.1093/jac/dks303
  11. Gozaydin A, Kose S, Ece G, Ersan G, Gonullu M. Detection of vancomycin resistant enterococci from rectal swab samples by Becton-Dickinson GeneOhm VanR assay and culture at ICU of a Tertiary Care Center in Turkey. Pak J Med Sci 2013;29(2):682-6.
  12. Kim JH, Kim JW, Kim SY, Hong DY, Park SO, Baek KJ, et al. Validation of the Korean triage and acuity scale compare to triage by emergency severity index for emergency adult patient: preliminary study in a tertiary hospital emergency medical center. J Korean Soc Emerg Med 2016;27:436-41.
  13. Kim YJ, Kim SI, Kim YR, Lee JY, Park YJ, Kang MW. Risk factors for vancomycin-resistant enterococci infection and mortality in colonized patients on intensive care unit admission. Am J Infect Control 2012;40(10):1018-9. https://doi.org/10.1016/j.ajic.2012.01.009
  14. Kim YJ, Kim SI, Choi JY, Yoon SK, You YK, Kim DG. Clinical significance of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci colonization in liver transplant recipients. Korean J Intern Med 2015;30(5):694-704. https://doi.org/10.3904/kjim.2015.30.5.694
  15. Yeung CS, Cheung CY, Chan YH, Chak WL. risk factors and outcomes of vancomycin-resistant Enterococcus colonization in patients on peritoneal dialysis: a single-center study in Hong Kong. Perit Dial Int 2017;37(5):556-61. https://doi.org/10.3747/pdi.2016.00278
  16. Gruber I, Heudorf U, Werner G, Pfeifer Y, Imirzalioglu C, Ackermann H, et al. Multidrug-resistant bacteria in geriatric clinics, nursing homes, and ambulant care--prevalence and risk factors. Int J Med Microbiol 2013;303(8):405-9. https://doi.org/10.1016/j.ijmm.2013.05.002
  17. Mody L, Foxman B, Bradley S, McNamara S, Lansing B, Gibson K, et al. Longitudinal assessment of multidrug-resistant organisms in newly admitted nursing facility patients: implications for an evolving population. Clin Infect Dis 2018;67(6):837-44. https://doi.org/10.1093/cid/ciy194
  18. Gouliouris T, Warne B, Cartwright EJ, Bedford L, Weerasuriya CK, Raven KE, et al. Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: a nested case-control study. J Antimicrob Chemother 2018;73(6):1692-9. https://doi.org/10.1093/jac/dky075
  19. Nucleo E, Caltagirone M, Marchetti VM, D'Angelo R, Fogato E, Confalonieri M, et al. Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria. Antimicrob Resist Infect Control 2018;7(1):33. https://doi.org/10.1186/s13756-018-0326-0

Cited by

  1. Emerging Anti-Microbial Resistance in Febrile Neutropenia: Is it high time to evaluate quality control measures? vol.36, pp.6, 2018, https://doi.org/10.12669/pjms.36.6.2138
  2. Assessment of door handles as potential reservoirs of drug-resistant enterococci vol.44, pp.1, 2018, https://doi.org/10.1186/s42269-020-00462-1
  3. Genetic analysis of ESBL-producing Klebsiella pneumoniae isolated from UTI patients in Indonesia vol.27, pp.1, 2021, https://doi.org/10.1016/j.jiac.2020.08.007