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Occurrence of Co‐Colonization or Co‐Infection With Vancomycin‐Resistant Enterococci and Methicillin‐Resistant Staphylococcus aureus in a Medical Intensive Care Unit

David K. Warren , MD, Anand Nitin , MD, Cheri Hill , BS, Victoria J. Fraser , MD and Marin H. Kollef , MD
Infection Control and Hospital Epidemiology
Vol. 25, No. 2 (February 2004), pp. 99-104
DOI: 10.1086/502357
Stable URL: http://www.jstor.org/stable/10.1086/502357
Page Count: 6
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Occurrence of Co‐Colonization or Co‐Infection With Vancomycin‐Resistant Enterococci and Methicillin‐Resistant Staphylococcus aureus in a Medical Intensive Care Unit
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Abstract

OBJECTIVE.  To determine the occurrence of co‐colonization or co‐infection with VRE and MRSA among medical patients requiring intensive care. DESIGN.  Prospective, single‐center, observational study. SETTING.  A 19‐bed medical ICU in an urban teaching hospital. PATIENTS.  Adult patients requiring at least 48 hours of intensive care and having at least one culture performed for microbiologic evaluation. RESULTS.  Eight hundred seventy‐eight consecutive patients were evaluated. Of these patients, 402 (45.8%) did not have microbiologic evidence of colonization or infection with either VRE or MRSA, 355 (40.4%) were colonized or infected with VRE, 38 (4.3%) were colonized or infected with MRSA, and 83 (9.5%) had co‐colonization or co‐infection with VRE and MRSA. Multiple logistic regression analysis demonstrated that increasing age, hospitalization during the preceding 6 months, and admission to a long‐term–care facility were independently associated with colonization or infection due to VRE and co‐colonization or co‐infection with VRE and MRSA. The distributions of positive culture sites for VRE (stool, 86.7%; blood, 6.5%; urine, 4.8%; soft tissue or wound, 2.0%) and for MRSA (respiratory secretions, 34.1%; blood, 32.6%; urine, 17.1%; soft tissue or wound, 16.2%) were statistically different (P < .001). CONCLUSIONS.  Co‐colonization or co‐infection with VRE and MRSA is common among medical patients requiring intensive care. The recent emergence of vancomycin‐resistant Staphylococcus aureus and the presence of a patient population cocolonized or co‐infected with VRE and MRSA support the need for aggressive infection control measures in the ICU.

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