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Prevalence and risk factors for VRE colonisation in a tertiary hospital in Melbourne, Australia: a cross sectional study

Surendra Karki1, Leanne Houston2, Gillian Land3, Pauline Bass3, Rosaleen Kehoe3, Sue Borrell3, Kerrie Watson3, Denis Spelman4, Jacqueline Kennon3, Glenys Harrington4 and Allen C Cheng13*

Author Affiliations

1 Department of Epidemiology and Preventive Medicine, Infectious Disease Epidemiology Unit, Monash University, Melbourne, Australia

2 Infection Control, Eastern Health, Melbourne, Australia

3 Infection Prevention and Healthcare Epidemiology Infectious Diseases and Microbiology Unit, Alfred Health, Melbourne, Australia

4 Infection Control Consultancy, Melbourne, Australia

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Antimicrobial Resistance and Infection Control 2012, 1:31  doi:10.1186/2047-2994-1-31

Published: 8 October 2012

Abstract

Background

Vancomycin-resistant Enterococcus (VRE) has been established as a significant health-care associated problem since its first isolation in Australia in 1994. In this study, we measured the point prevalence and identified risk factors associated with vanB VRE colonisation in a tertiary care hospital in Melbourne, Australia where VRE has been endemic for 15 years.

Methods

A hospital-wide point prevalence survey was conducted on October 13, 2008 with colonisation detected using rectal swab culture. Patient’s demographic and medical information was collected through a review of medical records. Factors associated with VRE colonisation in univariate analysis were included in multivariate logistic regression model to adjust for confounding.

Results

The prevalence of VRE colonisation on the day of screening was 17.5% (95% CI, 13.7 to 21.9). VRE was detected from patients in each ward with the prevalence ranging from 3% to 29%. Univariate analysis showed the use of any antibiotic, meropenem, ciprofloxacin, diarrhoea and longer length of hospital stay were associated with increased risk of VRE colonisation (p<0.05). However, age, sex, proximity to VRE positive cases, use of other antibiotics including cephalosporins, vancomycin were not associated with increased risk (P>0.05). Multivariate analysis showed the exposure to meropenem (p=0.004), age (≥65 years) (p=0.036) and length of stay ≥7 days (p<0.001) as independent predictors of VRE colonisation.

Conclusion

Our study suggests that exposure to antibiotics may have been more important than recent cross transmission for a high prevalence of vanB VRE colonisation at our hospital.

Keywords:
VRE; Colonisation; Acquisition; Prevalence; Risk factors; Australia; VanB; Antibiotics