PMID- 31024976
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 2328-8957 (Print)
IS  - 2328-8957 (Electronic)
IS  - 2328-8957 (Linking)
VI  - 6
IP  - 4
DP  - 2019 Apr
TI  - Vancomycin-Resistant Enterococcus Acquisition in a Tertiary Care Hospital: 
      Testing the Roles of Antibiotic Use, Proton Pump Inhibitor Use, and Colonization 
      Pressure.
PG  - ofz139
LID - 10.1093/ofid/ofz139 [doi]
LID - ofz139
AB  - BACKGROUND: Vancomycin-resistant Enterococcus (VRE) is a leading cause of 
      healthcare-associated infections, and asymptomatic colonization precedes 
      infection. VRE continues to spread despite widespread application of 
      pathogen-specific control guidelines. A better understanding of the risk factors 
      for transmission is needed. METHODS: A retrospective matched case-control study 
      was performed from June 2013 through December 2016 in a single institution. 
      Patients in 6 intensive care units, 1 hematology and oncology unit, and 1 bone 
      marrow transplant unit were screened by means of rectal swab sampling on 
      admission and weekly thereafter. Case patients had a negative swab sample 
      followed by a positive sample >3 days after admission. Controls were closely 
      matched to case patients based on time from admission to the second swab sample, 
      unit in which the second sample was obtained, and date of admission. Comorbidity 
      data, procedures, healthcare settings and exposures, culture data, and duration 
      of antibiotic and proton pump inhibitor (PPI) therapy were abstracted from the 
      electronic medical record. A multivariable risk factor model for conversion was 
      generated using purposeful selection. RESULTS: A total of 551 case patients were 
      matched with controls. The largest modifiable effects on VRE acquisition were >/=1 
      day of vancomycin therapy (odd ratio, 1.98; P < .001), >/=1 day of aerobic 
      antibiotic therapy (1.90; P < .001), and a dose-dependent effect of PPI therapy 
      (odds ratio per day of therapy, 1.09; P < .001). Colonization pressures from 
      patients identified to be carriers and placed in contact precautions did not 
      confer increased risk. CONCLUSIONS: Decreasing PPI use and preventing the 
      inappropriate initiation of antibiotic therapy are modifiable targets to decrease 
      VRE transmission in the hospital.
FAU - Chanderraj, Rishi
AU  - Chanderraj R
AUID- ORCID: 0000-0001-8081-5258
AD  - University of Michigan, Ann Arbor.
FAU - Millar, Jess A
AU  - Millar JA
AD  - University of Michigan, Ann Arbor.
FAU - Patel, Twisha S
AU  - Patel TS
AD  - University of Michigan, Ann Arbor.
FAU - Read, Andrew F
AU  - Read AF
AD  - Pennsylvania State University, State College.
FAU - Washer, Laraine
AU  - Washer L
AD  - University of Michigan, Ann Arbor.
FAU - Kaye, Keith S
AU  - Kaye KS
AD  - University of Michigan, Ann Arbor.
FAU - Woods, Robert J
AU  - Woods RJ
AD  - University of Michigan, Ann Arbor.
LA  - eng
GR  - K08 AI119182/AI/NIAID NIH HHS/United States
GR  - L30 AI113834/AI/NIAID NIH HHS/United States
PT  - Journal Article
DEP - 20190315
PL  - United States
TA  - Open Forum Infect Dis
JT  - Open forum infectious diseases
JID - 101637045
PMC - PMC6475592
OTO - NOTNLM
OT  - hospital acquisition
OT  - proton pump inhibitor
OT  - risk factors
OT  - vancomycin resistant Enterococcus
EDAT- 2019/04/27 06:00
MHDA- 2019/04/27 06:01
PMCR- 2019/03/15
CRDT- 2019/04/27 06:00
PHST- 2018/10/31 00:00 [received]
PHST- 2019/03/12 00:00 [accepted]
PHST- 2019/04/27 06:00 [entrez]
PHST- 2019/04/27 06:00 [pubmed]
PHST- 2019/04/27 06:01 [medline]
PHST- 2019/03/15 00:00 [pmc-release]
AID - ofz139 [pii]
AID - 10.1093/ofid/ofz139 [doi]
PST - epublish
SO  - Open Forum Infect Dis. 2019 Mar 15;6(4):ofz139. doi: 10.1093/ofid/ofz139. 
      eCollection 2019 Apr.