Program Schedule

Risk Factors for Vancomycin-resistant Enterococci and Carbapenemase-producing Carbapenem-resistant Enterobacteriaceae Colonization at admission to a Tertiary-care Center

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Vancomycin-resistant Enteroccocus (VRE) and Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) infections are rapidly emerging in Singapore. Colonization often precedes infection. But, prevalence and factors associated with VRE and CP-CRE colonization remain unknown. 

Our study aims to determine the prevalence of VRE and CP-CRE colonization at admission and factors associated with colonization in an adult tertiary-care center in Singapore.  


All new admissions (<48 hours) to 1600 bed Tan Tock Seng Hospital, Nov 3-7 2013, were screened for VRE and CP-CRE via rectal swabs using selective culture media. A multiplex PCR with primers targeting blaNDM, blaKPC, blaOXA-48-like, blaIMP and blaIMI was done on meropenem non-susceptible Enterobacteriaceae isolates. Clinical data was obtained from medical records. VRE and CP-CRE colonizers were compared with non-colonizers in case-control studies. To compare differences in covariates between groups, odds ratios and 95% confidence intervals were computed. Multiple logistic regression models were constructed to control for confounding and determine independent factors.


Of 684 patients screened, 13 (1.9%) were colonized with VRE (8 Van A and 5 Van B) and 5 (0.7%) with CP-CRE (2 NDM, 1 KPC, 1 IMP, 1 IMI). Compared to non-colonizers, VRE-colonizers were more likely to have been hospitalized locally in the past 1 year (OR 17.71, 95%CI 2.14-146.68) and exposed to indwelling devices (OR 10.21, 95%CI 2.03-51.31). There was no difference in age, gender, comorbidity, and prior hospitalization overseas. After adjusting for age, gender, and comorbidity, exposure to indwelling devices (Adj OR 9.60, 95%CI 1.45-63.53) was independently associated with VRE colonization. In contrast, CP-CRE colonizers were more likely than non-colonizers to have had a past infection with a multidrug-resistant organism (MDRO) (OR 18.00, 95%CI 2.30-141.17). After adjusting for age, gender, and comorbidity, past MDRO infection (Adj OR 14.20, 95%CI 1.68-119.76) was significantly associated with CP-CRE colonization.      


The prevalence of VRE and CP-CRE colonization at admission was low. Prior exposure to indwelling devices was associated with VRE colonization whilst past MDRO infection with CP-CRE colonization. Patients with such exposures should be actively screened at admission.

Angela Chow, MBBS, MPH, MS1, Kalisvar Marimuthu, MBBS, MRCP1, Bee Fong Poh, RN2, Nwe-Ni Win, MBBS3, Jia Qi Kum, BSc2 and Brenda Ang, MBBS, M Med, MPH, FAMS1, (1)Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore, (2)Infection Control, Tan Tock Seng Hospital, Singapore, Singapore, (3)Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore


A. Chow, None

K. Marimuthu, None

B. F. Poh, None

N. N. Win, None

J. Q. Kum, None

B. Ang, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

Sponsoring Societies:

© 2014, All Rights Reserved.

Follow IDWeek