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Recovery of both vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus from culture of a single clinical specimen from colonized or infected patients.

Authors
 Sang Hoon Han  ;  Bum Sik Chin  ;  Han Sung Lee  ;  Su Jin Jeong  ;  Hee Kyung Choi  ;  Chang Ki Kim  ;  Chang Oh Kim  ;  Dongeun Yong  ;  Jun Yong Choi  ;  Young Goo Song  ;  Kyungwon Lee  ;  June Myung Kim 
Citation
 Infection Control and Hospital Epidemiology, Vol.30(2) : 130-138, 2009 
Journal Title
 Infection Control and Hospital Epidemiology 
ISSN
 0899-823X 
Issue Date
2009
MeSH
Adult ; Aged ; Carrier State*/epidemiology ; Carrier State*/microbiology ; Case-Control Studies ; Cohort Studies ; Culture Media ; Enterococcus/classification ; Enterococcus/drug effects ; Enterococcus/isolation & purification* ; Female ; Gram-Positive Bacterial Infections*/complications ; Gram-Positive Bacterial Infections*/epidemiology ; Gram-Positive Bacterial Infections*/microbiology ; Hospitals, University ; Humans ; Incidence ; Korea/epidemiology ; Male ; Methicillin-Resistant Staphylococcus aureus/drug effects ; Methicillin-Resistant Staphylococcus aureus/isolation & purification* ; Middle Aged ; Risk Factors ; Staphylococcal Infections*/complications ; Staphylococcal Infections*/epidemiology ; Staphylococcal Infections*/microbiology ; Vancomycin Resistance*
Abstract
OBJECTIVE: To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients. DESIGN: A retrospective cohort and case-control study. SETTING: A tertiary care university hospital and referral center in Seoul, Korea. METHODS: We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2:1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis. RESULTS: The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00; P=.012 ), urinary catheterization (OR, 3.36; P=.026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03; P < .001). CONCLUSION: We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer of vanA, close observation and surveillance for vancomycin-resistant S. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.
Full Text
http://www.jstor.org/stable/10.1086/593957
DOI
10.1086/593957
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Kim, June Myung(김준명)
Kim, Chang Ki(김창기)
Kim, Chang Oh(김창오) ORCID logo https://orcid.org/0000-0002-0773-5443
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Yong, Dong Eun(용동은) ORCID logo https://orcid.org/0000-0002-1225-8477
Lee, Kyungwon(이경원) ORCID logo https://orcid.org/0000-0003-3788-2134
Lee, Han Sung(이한성)
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Chin, Bum Sik(진범식)
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
Choi, Hee Kyoung(최희경)
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/103366
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