Methods: We performed a retrospective matched case control study from June 2013 through December 2016 in a single institution. Patients admitted to eight units were routinely screened on admission and weekly thereafter. Cases had a negative swab followed by positive swab more than 3 days after admission. Controls were matched to time from admission to second swab (+/- 5%), unit on which the second swab was performed, and date of admission (+/-365 days). Co-morbidity data, culture data, and antibiotic and proton pump inhibitor (PPI) days on therapy (DOT) were abstracted from the electronic medical record and verified by manual checking 5% of the cohort. A comorbidity risk factor model was generated using conditional logistic regression and backward stepwise removal by AIC criterion to identify comorbidities significantly associated with conversion. With the best fit comorbidity model, colonization pressure, antibiotic use and PPI use were tested.
Results: We identified 551 cases with matched controls. The comorbidities conferring significantly increased odds ratio (OR) of converting from swab negative to swab positive include age (OR 1.01 per year, p = 0.035), time to index swab (OR 1.5, p = 0.026), neutropenia (OR 1.62, p = 0.014) and renal failure (OR 1.8, p = 0.013). Having one or more DOT of any systemic antibiotic was the largest effect on conversion to VRE positivity (OR 5.6, p < 0.001), but total antibiotic DOT was not significant. Each PPI DOT conferred an OR of 1.06 (p < 0.001). Colonization pressures from patients identified to be carriers and placed in contact precautions did not confer and increased risk.
Conclusion: : Decreasing PPI use and preventing the initiation of antibiotic when possible should be considered to decrease VRE transmission in the hospital.
C. Kinnear, None
A. Read, None
L. L. Washer, None
K. S. Kaye, Xellia: Consultant , Consulting fee
Merck: Consultant and Grant Investigator , Consulting fee and Research support
The Medicines Company: Consultant and Grant Investigator , Consulting fee and Research support
R. Woods, None