Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada

Publication date: Available online 11 June 2018
Source:American Journal of Infection Control
Author(s): Jennie Johnstone, Cynthia Chen, Laura Rosella, Kwaku Adomako, Michelle E. Policarpio, Freda Lam, Chatura Prematunge, Gary Garber
BackgroundData are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia.MethodsAll patients with a confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013 were linked to provincial healthcare administrative data sources and frequency matched to 3 controls based on age, sex, and aggregated diagnosis group. Associations between predictors and VRE bacteremia were estimated by generalized estimating equations and summarized using odds ratios (ORs) and corresponding 95% confidence intervals (CIs).ResultsIn total, 217 cases and 651 controls were examined. In adjusted analyses, patient-level predictors included bone marrow transplant (OR 106.99 [95% CI 12.19–939.26]); solid organ transplant (OR 17.17 [95% CI 4.95–59.54]); any cancer (OR 8.64 [95% CI 3.88–19.21]); intensive care unit (ICU) admission (OR 6.81 [95% CI 3.53–13.13]); heart disease (OR 5.27 [95% CI 2.00–13.90]); and longer length of stay (OR 1.07 per day [95% CI 1.06–1.09]). Hospital-level predictors included hospital size (per increase in 100 beds (OR 1.26 [95% CI 1.07–1.48]) and teaching hospitals (OR 3.87 [95% CI 1.85–8.08]).ConclusionsPatients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the ICU are at highest risk of VRE bacteremia, particularly at large hospitals and teaching hospitals.



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