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Co-Carriage Rates of Vancomycin-Resistant Enterococcus and Extended-Spectrum Beta-Lactamase-Producing Bacteria Among a Cohort of Intensive Care Unit Patients: Implications for an Active Surveillance Program

Published online by Cambridge University Press:  02 January 2015

Anthony D. Harris ,
Lucia Nemoy ,
Judith A. Johnson ,
Amy Martin-Carnahan ,
David L. Smith ,
Hal Standiford  and
Eli N. Perencevich
Anthony D. Harris
Affiliation:
Department of Epidemiology and Preventive Medicine Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Lucia Nemoy
Affiliation:
Department of Epidemiology and Preventive Medicine
Judith A. Johnson
Affiliation:
Department of Pathology, University of Maryland Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Amy Martin-Carnahan
Affiliation:
Department of Epidemiology and Preventive Medicine
David L. Smith
Affiliation:
Department of Epidemiology and Preventive Medicine Fogarty International Center, National Institutes of Health, Bethesda, Maryland
Hal Standiford
Affiliation:
University of Maryland Medical System, Baltimore, Maryland
Eli N. Perencevich
Affiliation:
Department of Epidemiology and Preventive Medicine Veterans Affairs Maryland Health Care System, Baltimore, Maryland
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Abstract

Objective:

To assess the co-colonization rates of extended-spectrum beta-lactamase (ESBL)-producing bacteria and vancomycin-resistant Enterococcus (VRE) obtained on active surveillance cultures.

Design:

Prospective cohort study.

Setting:

Medical and surgical intensive care units (ICUs) of a tertiary-care hospital.

Patients:

Patients admitted between September 2001 and November 2002 to the medical and surgical ICUs at the University of Maryland Medical System had active surveillance perirectal cultures performed. Samples were concurrently processed for VRE and ESBL-producing bacteria.

Results:

Of 1,362 patients who had active surveillance cultures on admission, 136 (10%) were colonized with VRE. Among these, 15 (positive predictive value, 11%) were co-colonized with ESBL. Among the 1,226 who were VRE negative, 1,209 were also ESBL negative (negative predictive value, 99%). Among the 1,362 who had active surveillance cultures on admission, 32 (2%) were colonized with ESBL. Among these, 15 (47%) were co-colonized with VRE. Of the 32 patients colonized with ESBL, 10 (31%) had positive clinical cultures for ESBL on the same hospital admission. For these 10 patients, the surveillance cultures were positive an average of 2.7 days earlier than the clinical cultures.

Conclusions:

Patients who are colonized with VRE can also be co-colonized with other antibiotic-resistant bacteria such as ESBL-producing bacteria. Our study is the first to measure co-colonization rates of VRE and ESBL-producing bacteria. Isolating VRE-colonized patients would isolate 47% of the ESBL-colonized patients without the need for further testing. Hence, active surveillance for VRE should also theoretically diminish the amount of patient-to-patient transmission of ESBL-producing bacteria.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 2 , February 2004 , pp. 105 - 108
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Knothe, H, Shah, P, Krcmery, V, Antal, M, Mitsuhashi, S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983;11:315–317.Google Scholar
2.Quinn, JP, Miyashiro, D, Sahm, D, Flamm, R, Bush, K. Novel plasmid-mediated beta-lactamase (TEM-10) conferring selective resistance to ceftazidime and aztreonam in clinical isolates of Klebsiella pneumoniae. Antimicrob Agents Chemother 1989;33:1451–1456.Google Scholar
3.Bradford, PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001;14:933–951.Google Scholar
4.National Nosocomial Infections Surveillance System. Antimicrobial Surveillance Report. Atlanta, GA: National Nosocomial Infections Surveillance System; 2000.Google Scholar
5.Sahm, DF, Kissinger, J, Gilmore, MS, et al.In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis. Antimicrob Agents Chemother 1989;33:1588–1591.Google Scholar
6.Siddiqui, AH, Harris, AD, Hebden, J, Wilson, PD, Morris, JG, Roghmann, MC. The effect of active surveillance for vancomycin-resistant enterococci in high-risk units on vancomycin-resistant enterococci incidence hospital-wide. Am J Infect Control 2002;30:40–43.Google Scholar
7.Ostrowsky, BE, Trick, WE, Sohn, AH, et al.Control of vancomycin-resistant Enterococcus in health care facilities in a region. N Engl J Med 2001;344:1427–1433.Google Scholar
8.Jochimsen, EM, Fish, L, Manning, K, et al.Control of vancomycin-resistant enterococci at a community hospital: efficacy of patient and staff cohorting. Infect Control Hosp Epidemiol 1999;20:106–109.Google Scholar
9.Montecalvo, MA, Jarvis, WR, Uman, J, et al.Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemie setting. Ann Intern Med 1999;131:269–272.Google Scholar
10.Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, Enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834–844.Google Scholar
11.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 1999.Google Scholar
12.Lucet, JC, Chevret, S, Deere, D, et al.Outbreak of multiply resistant enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin Infect Dis 1996;22:430–436.Google Scholar
13.Pena, C, Pujol, M, Ricart, A, et al.Risk factors for faecal carriage of Klebsiella pneumoniae producing extended spectrum beta-lactamase (ESBL-KP) in the intensive care unit. J Hosp Infect 1997;35:9–16.Google Scholar
14.Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outeomes. Clin Infect Dis 2001;32:1162–1171.Google Scholar
15.Jacoby, GA. Extended-spectrum beta-lactamases and other enzymes providing resistance to oxyimino-beta-lactams. Infect Dis Clin North Am 1997;11:875–887.Google Scholar
16.Wiener, J, Quinn, JP, Bradford, PA, et al.Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517–523.Google Scholar
17.Ostrowsky, B, Steinberg, JT, Farr, B, Sohn, AH, Sinkowitz-Cochran, RL, Jarvis, WR. Reality check: should we try to detect and isolate vancomycin-resistant enterococci patients? Infect Control Hosp Epidemiol 2001;22:116–119.Google Scholar
18.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.Google Scholar
19.Lam, S, Singer, C, Tucci, V, Morthland, VH, Pfaller, MA, Isenberg, HD. The challenge of vancomycin-resistant enterococci: a clinical and epidemiologic study. Am J Infect Control 1995;23:170–180.Google Scholar
20.Montecalvo, MA, de Lencastre, H, Carraher, M, et al.Natural history of colonization with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1995;16:680–685.Google Scholar
21.Ostrowsky, BE, Venkataraman, L, D'Agata, EM, Gold, HS, DeGirolami, PC, Samore, MH. Vancomycin-resistant enterococci in intensive care units: high frequency of stool carriage during a non-outbreak period. Arck Intern Med 1999;159:1467–1472.Google Scholar
22.Muto, CA, Giannetta, ET, Durbin, U, Simonton, BM, Farr, BM. Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002;23:429–435.Google Scholar
23.Edmond, M. Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2003;24:309–310.Google Scholar