Infection Control and Hospital Epidemiology Publication Info
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A Hospital Epidemic of Vancomycin‐Resistant Enterococcus: Risk Factors and Control
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Abstract(back to top)
OBJECTIVE. To determine risk factors for vancomycinresistant Enterococcus (VRE) colonization during a hospital outbreak and to evaluate Centers for Disease Control and Prevention (CDC)‐recommended control measures.
DESIGN. Epidemiological study involving prospective identification of colonization and a case‐control study.
SETTING. A university hospital.
PARTICIPANTS. Patients on eight wards involved in outbreak from late 1994 through early 1995.
METHODS. Cases were matched by ward and culture date with up to two controls. Risk factors were evaluated with four multivariate models using conditional logistic regression. The first evaluated proximity to other VRE patients and isolation status. The second evaluated proximity to unisolated VRE cases and three variables independently predictive after adjustment for proximity. The third evaluated seven significant univariate predictors in addition to proximity to unisolated VRE in backward, stepwise logistic regression. The fourth assessed proximity to VRE with all other variables collected, clustered in a principal components analysis. Pulsed‐field gel electrophoresis was performed to assess clonality of two outbreak strains.
RESULTS. The incidence of transmission declined significantly after CDC guidelines were implemented. Proximity to unisolated VRE cases during the prior week was a significant predictor of acquisition in each of four multivariate models. Other significant risk factors in multivariate models included a history of major trauma and treatment with metronidazole. Pulsed‐field gel electrophoresis confirmed the clonality of two outbreak strains.
CONCLUSIONS. VRE was transmitted between patients during a hospital epidemic, with proximity to previously unisolated VRE patients being an important risk factor. Weekly surveillance cultures and contact isolation of colonized patients significantly reduced spread.
Bibliographic Information(back to top)
- A Hospital Epidemic of Vancomycin‐Resistant Enterococcus: Risk Factors and Control
- Karin E. Byers , MD, MS, Anne M. Anglim , MD, MS, Cynthia J. Anneski , MD, Teresa P. Germanson , MPH, PhD, Howard S. Gold , MD, Lisa J. Durbin , BS, MT(ASCP), Barbara M. Simonton , CLT(HEW) and Barry M. Farr , MD, MSc
- Infection Control and Hospital Epidemiology
- Vol. 22, No. 3 (March 2001) (pp. 140-147)
Notes and References(back to top)
This item contains 1 note(s).
Notes
From the University of Virginia Health System (Drs. Byers, Anglim, Anneski, Germanson, and Farr; Ms. Durbin and Ms. Simonton), Charlottesville, Virginia; and Harvard Medical School (Dr. Gold), Boston, Massachusetts.Address reprint requests to Barry M. Farr, MD, MSc, Box 800473, University of Virginia Health System, Charlottesville, VA 22908.The authors wish to acknowledge Robert Moellering, MD, for advice regarding molecular typing; Frank Harrell, PhD, for help in variable clustering and data reduction; Rebecca L. Buxton for technical assistance; and Helen Norfleet‐Shiflett and Angelia Cempré for assistance with manuscript preparation.00‐OA‐096. Byers KE, Anglim AM, Anneski CJ, Germanson TP, Gold HS, Durbin LJ, Simonton BM, Farr BM. A hospital epidemic of vancomycinresistant Enterococcus: risk factors and control. Infect Control Hosp Epidemiol 2001;22:140‐147.
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