Epidemiology of vancomycin-resistant enterococci in postacute care facility and predictors of clearance: A 5-year retrospective cohort study

Abstract

Background

There have been no local studies on the duration and risk factors for vancomycin-resistant enterococcus (VRE) colonization in a postacute convalescence hospital. Our aim was to investigate the duration of VRE colonization and risk factors for prolonged carriage among patients admitted to a convalescence hospital.

Methods

The case records of patients admitted to a 400-bed convalescence care hospital with rectal swab or stool culture samples positive for VRE from January 2010 to December 2014 were retrieved. The clinical characteristics associated with clearance of colonization within the hospitalization period were analyzed, and logistic regression was set up to detect for factors associated with inpatient and 1-year mortality.

Results

A total of 121 patients (mean age, 81.45 years) were colonized with VRE. The inpatient clearance rate was only 35.5%. The median time to VRE clearance during the hospital stay was 43 days. The independent predictors for VRE colonization during hospitalization were old-age-home residents [odds ratio (OR) = 2.72; 95% confidence interval (CI), 1.14–6.48] and antibiotics use (OR = 4.27; 95% CI, 1.89–9.62). Inpatient mortality was higher among those with persistent VRE colonization upon discharge (39.7% vs. 18.6%, p = 0.017). Presence of wound or bed sores (OR = 4.58; 95% CI, 1.16–13.2), chair/bed bound status (OR = 3.64; 95% CI, 1.27–10.46), and persistent VRE colonization (OR = 12.4; 95% CI, 3.16–42.52) were predictors for 1-year mortality.

Conclusion

The strongest risk factor for prolonged VRE carriage was old-age-home residents. Survival is adversely affected by VRE carriage and functional mobility. Patients with these factors should be managed more carefully, and active surveillance should be focused on this high-risk group to prevent spread of transmission.