Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-19T10:44:53.428Z Has data issue: false hasContentIssue false
  • English
  • Français

Antibiotic Exposure and Room Contamination Among Patients Colonized With Vancomycin-Resistant Enterococci

Published online by Cambridge University Press:  02 January 2015

Marci Drees ,
David R. Snydman ,
Christopher H. Schmid ,
Laurie Barefoot ,
Karen Hansjosten ,
Padade M. Vue ,
Michel Cronin ,
Stanley A. Nasraway  and
Yoav Golan
Marci Drees*
Affiliation:
Tufts Medical Center, Boston Sakler School of Graduate Biomedical Sciences, Boston School of Medicine, Tufts University, Boston Christiana Care Health System Center for Outcomes Research, Newark, Delaware
David R. Snydman
Affiliation:
Tufts Medical Center, Boston Sakler School of Graduate Biomedical Sciences, Boston School of Medicine, Tufts University, Boston
Christopher H. Schmid
Affiliation:
Tufts Medical Center, Boston Sakler School of Graduate Biomedical Sciences, Boston
Laurie Barefoot
Affiliation:
Tufts Medical Center, Boston
Karen Hansjosten
Affiliation:
Tufts Medical Center, Boston
Padade M. Vue
Affiliation:
School of Medicine, Tufts University, Boston
Michel Cronin
Affiliation:
Tufts University, Medford, Massachusetts
Stanley A. Nasraway
Affiliation:
Tufts Medical Center, Boston School of Medicine, Tufts University, Boston
Yoav Golan
Affiliation:
Tufts Medical Center, Boston School of Medicine, Tufts University, Boston
*
Christiana Care Health System Center for Outcomes Research, 131 Continental Drive, Suite 202, Newark, DE 19713 (mdrees@christianacare.org)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine whether total and antianaerobic antibiotic exposure increases the risk of room contamination among vancomycin-resistant enterococci (VRE)–colonized patients.

Design And Setting.

A 14-month study in 2 intensive care units at an academic tertiary care hospital in Boston, Massachusetts.

Patients.

All patients who acquired VRE or were VRE-colonized on admission and who had environmental cultures performed.

Methods.

We performed weekly environmental cultures (2 sites per room) and considered a room to be contaminated if there was a VRE-positive environmental culture during the patient's stay. We determined risk factors for room contamination by use of the Cox proportional hazards model.

Results.

Of 142 VRE-colonized patients, 35 (25%) had an associated VRE-positive environmental culture. Patients who contaminated their rooms were more likely to have diarrhea than those who did not contaminate their rooms (23 [66%] of 35 vs 41 [38%] of 107; P = .005) and more likely to have received antibiotics while VRE colonized (33 [94%] of 35 vs 86 [80%] of 107; P = .02). There was no significant difference in room contamination rates between patients exposed to antianaerobic regimens and patients exposed to nonantianaerobic regimens or between patients with and patients without diarrhea, but patients without any antibiotic exposure were unlikely to contaminate their rooms. Diarrhea and antibiotic use were strongly confounded; although two-thirds of room contamination occurred in rooms of patients with diarrhea, nearly all of these patients received antibiotics. In multivariable analysis, higher mean colonization pressure in the ICU increased the risk of room contamination (adjusted hazard ratio per 10% increase, 1.44 [95% confidence interval, 1.04–2.04]), whereas no antibiotic use during VRE colonization was protective (adjusted hazard ratio, 0.21 [95% confidence interval, 0.05–0.89]).

Conclusions.

Room contamination with VRE was associated with increased mean colonization pressure in the ICU and diarrhea in the VRE-colonized patient, whereas no use of any antibiotics during VRE colonization was protective.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 709 - 715
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Bhalla, A, Pultz, NJ, Gries, DM, et al.Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infect Control Hosp Epidemiol 2004;25:164–167.CrossRefGoogle ScholarPubMed
2.Bures, S, Fishbain, JT, Uyehara, CF, Parker, JM, Berg, BW. Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 2000;28:465–471.CrossRefGoogle ScholarPubMed
3.Weber, DJ, Rutala, WA. Role of environmental contamination in the transmission of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1997;18:306–309.Google Scholar
4.Byers, KE, Anglim, AM, Anneski, CJ, Farr, BM. Duration of colonization with vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002;23:207–211.CrossRefGoogle ScholarPubMed
5.Morris, JG Jr, Shay, DK, Hebden, JN, et al.Enterococci resistant to multiple antimicrobial agents, including vancomycin: establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250–259.Google Scholar
6.Huang, SS, Datta, R, Piatt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.Google Scholar
7.Drees, M, Snydman, DR, Schmid, CH, et al.Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678–685.CrossRefGoogle ScholarPubMed
8.Martínez, JA, Ruthazer, R, Hansjosten, K, Barefoot, L, Snydman, DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med 2003;163:1905–1912.CrossRefGoogle Scholar
9.Hayden, MK, Bonten, MJ, Blom, DW, Lyle, EA, van de Vijver, DA, Weinstein, RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:1552–1560.Google Scholar
10.Ray, AJ, Hoyen, CK, Das, SM, Eckstein, EC, Donskey, CJ. Undetected vancomycin-resistant Enterococcus stool colonization in a veterans affairs hospital using a Clostridium difficile-focused surveillance strategy. Infect Control Hosp Epidemiol 2002;23:474–477.Google Scholar
11.Duckro, AN, Blom, DW, Lyle, EA, Weinstein, RA, Hayden, MK. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302–307.Google Scholar
12.Boyce, JM, Opal, SM, Chow, JW, et al.Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol 1994;32:1148–1153.Google Scholar
13.Donskey, CJ, Chowdhry, TK, Hecker, MT, et al.Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:1925–1932.Google Scholar
14.Beezhold, DW, Slaughter, S, Hayden, MK, et al.Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis 1997;24:704–706.Google Scholar
15.Moreno, F, Grota, P, Crisp, C, et al.Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium during its emergence in a city in southern Texas. Clin Infect Dis 1995;21:1234–1237.CrossRefGoogle Scholar
16.Weinstein, JW, Roe, M, Towns, M, et al.Resistant enterococci: a prospective study of prevalence, incidence, and factors associated with colonization in a university hospital. Infect Control Hosp Epidemiol 1996;17:36–41.Google Scholar
17.Edmond, MB, Ober, JF, Weinbaum, DL, et al.Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1126–1133.Google Scholar
18.Donskey, CJ, Hanrahan, JA, Hutton, RA, Rice, LB. Effect of parenteral antibiotic administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis 1999;180:384–390.Google Scholar
19.Donskey, CJ, Helfand, MS, Pultz, NJ, Rice, LB. Effect of parenteral fluoroquinolone administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. Antimicrobial Agents Chemother 2004;48:326–328.Google Scholar
20.Edlund, C, Barkholt, L, Olsson-Lih'equist, B, Nord, CE. Effect of vancomycin on intestinal flora of patients who previously received antimicrobial therapy. Clin Infect Dis 1997;25:729–732.Google Scholar
21.Bodey, GP, Fainstein, V, Garcia, I, Rosenbaum, B, Wong, Y. Effect of broad-spectrum cephalosporins on the microbial flora of recipients. J Infect Dis 1983;148:892–897.Google Scholar
22.Arvidsson, A, Leijd, B, Nord, CE, Angelin, B. Interindividual variability in biliary excretion of ceftriaxone: effects on biliary lipid metabolism and on intestinal microflora. Eur J Clin Invest 1988;18:261–266.Google Scholar
23.Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972–978.Google Scholar
24.Golan, Y, Doron, S, Griffith, J, et al.The impact of gown-use requirement on hand hygiene compliance. Clin Infect Dis 2006;42:370–376.Google Scholar
25.Pultz, NJ, Stiefel, U, Donskey, CJ. Effects of daptomycin, linezolid, and vancomycin on establishment of intestinal colonization with vancomycin-resistant enterococci and extended-spectrum-β-lactamase-producing Klebsiella pneumoniae in mice. Antimicrobial Agents Chemother 2005;49:3513–3516.Google Scholar
26.Bhalla, A, Pultz, NJ, Ray, AJ, Hoyen, CK, Eckstein, EC, Donskey, CJ. Anti-anaerobic antibiotic therapy promotes overgrowth of antibiotic-resistant, gram-negative bacilli and vancomycin-resistant enterococci in the stool of colonized patients. Infect Control Hosp Epidemiol 2003;24:644–649.Google Scholar
27.Currie, BP, Lemos-Filho, L. Evidence for biliary excretion of vancomycin into stool during intravenous therapy: potential implications for rectal colonization with vancomycin-resistant enterococci. Antimicrobial Agents Chemother 2004;48:4427–4429.Google Scholar
28.Itokazu, GS, Glowacki, RC, Schwartz, DN, Wisniewski, MF, Rydman, RJ, Weinstein, RA. Antimicrobial consumption data from pharmacy and nursing records: how good are they? Infect Control Hosp Epidemiol 2005;26:395–400.Google Scholar
29.Sullivan, A, Edlund, C, Nord, CE. Effect of antimicrobial agents on the ecological balance of human microflora. Lancet Infect Dis 2001;1:101–114.Google Scholar
30.Eckstein, BC, Adams, DA, Eckstein, EC, et al.Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.Google Scholar
31.Ray, AJ, Hoyen, CK, Taub, TF, Eckstein, EC, Donskey, CJ. Nosocomial transmission of vancomycin-resistant enterococci from surfaces. JAMA 2002;287:1400–1401.Google Scholar
32.Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Blom, DW, Weinstein, RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: The effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166:306–312.CrossRefGoogle Scholar
33.Bonten, MJ, Slaughter, S, Ambergen, AW, et al.The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: An important infection control variable. Arch Intern Med 1998;158:1127–1132.CrossRefGoogle ScholarPubMed