276. Risk Factors for MRSA-VRE Coinfection Among Hospitalized Adults
Session: Poster Abstract Session: HAI: MSSA, MRSA, and other Gram-Positives
Thursday, October 27, 2016
Room: Poster Hall
Background: Vancomycin-resistant S. aureus (VRSA) has been reported sporadically in the United States and with increasing frequency internationally. Coincident infection or colonization with MRSA and VRE in a single individual is a key precursor to VRSA emergence. Our objective was to examine risk factors for MRSA-VRE coinfection among hospitalized adults in southeastern Michigan, home to numerous VRSA case reports.

Methods: Cases, defined as patients with both MRSA and VRE identified from clinical cultures within 7 days, were prospectively identified from 2012-2016 at 6 Detroit Medical Center hospitals. Cases were matched to controls with MRSA-only and with VRE-only cultures based on hospital, infection site, VRE species, intensive care unit admission, and time since admission. Demographic and clinical histories were abstracted from medical records. Cases were compared separately to each control group using conditional logistic regression, accounting for matched pairs.

Results: 151 MRSA-VRE case patients were identified during the study period, 90 had complete clinical data to date. 43% of case patients were admitted to the intensive care unit at the time of culture. MRSA-VRE case status was associated with non-home residence (OR=3.3 (95% C.I. 1.4, 7.7); p<0.01), history of chronic skin wounds (OR=4.8 (95% C.I. 1.8, 12.6) p<0.01), and presence of a medical device (OR=3.0 (95% C.I. 1.3, 7.1); p=0.01) when compared to patients with MRSA only (71 total pairs). MRSA-VRE case status was associated with lower body mass index when compared to patients with VRE only (median 25 vs 28, respectively; p<0.01) but were not significantly different for other demographic or clinical factors. MRSA-VRE case status was not associated with diabetes for either comparison (p=0.84 for both).

Conclusion: Risk factors for MRSA-VRE coinfection, compared to MRSA alone, included factors frequently tied to colonization with resistant organisms, including long term acute care, medical device use and history of skin wounds. Few differences were observed between MRSA-VRE and VRE-alone, although sample size was small for this comparison. Diabetes, previously reported as a common comorbidity in VRSA cases, was not associated with MRSA-VRE co-colonization.

Katherine Hanslits, MPH Candidate1, Richard Evans, MS1, Maria Konja, MPH Candidate1, Mariam Akhtar, BS1, Kathryn Sutcliffe, MPH1, Jesse Kim, .1, Madiha Salim, MD2, Elizabeth Salzman, MS1, Keith Kaye, MD3 and Emily T. Martin, MPH, PhD1, (1)University of Michigan School of Public Health, Ann Arbor, MI, (2)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI, (3)Medicine, Wayne State University, Detroit, MI

Disclosures:

K. Hanslits, None

R. Evans, None

M. Konja, None

M. Akhtar, None

K. Sutcliffe, None

J. Kim, None

M. Salim, None

E. Salzman, None

K. Kaye, None

E. T. Martin, None

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