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

Hoon Han Sang, Sik Chin Bum, Sung Lee Han, Jin Jeong Su, Kyung Choi Hee, Ki Kim Chang, Oh Kim Chang, Dongeun Yong, Yong Choi Jun, Goo Song Young, Kyungwon Lee, Myung Kim June

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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 atients 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.

Original languageEnglish
Pages (from-to)130-138
Number of pages9
JournalInfection Control and Hospital Epidemiology
Volume30
Issue number2
DOIs
Publication statusPublished - 2009 Feb 1

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Methicillin-Resistant Staphylococcus aureus
Odds Ratio
Vancomycin-Resistant Enterococci
Urinary Catheterization
Incidence
Tertiary Healthcare
Vancomycin
Korea
Chronic Renal Insufficiency
Respiratory System
Staphylococcus aureus
Case-Control Studies
Length of Stay
Referral and Consultation
Catheters
Logistic Models
Regression Analysis
Observation
Urine

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Sang, Hoon Han ; Bum, Sik Chin ; Han, Sung Lee ; Su, Jin Jeong ; Hee, Kyung Choi ; Chang, Ki Kim ; Chang, Oh Kim ; Yong, Dongeun ; Jun, Yong Choi ; Young, Goo Song ; Lee, Kyungwon ; June, Myung Kim. / Recovery of both vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus from culture of a single clinical specimen from colonized or infected patients. In: Infection Control and Hospital Epidemiology. 2009 ; Vol. 30, No. 2. pp. 130-138.
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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 atients 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.",
author = "Sang, {Hoon Han} and Bum, {Sik Chin} and Han, {Sung Lee} and Su, {Jin Jeong} and Hee, {Kyung Choi} and Chang, {Ki Kim} and Chang, {Oh Kim} and Dongeun Yong and Jun, {Yong Choi} and Young, {Goo Song} and Kyungwon Lee and June, {Myung Kim}",
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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. / Sang, Hoon Han; Bum, Sik Chin; Han, Sung Lee; Su, Jin Jeong; Hee, Kyung Choi; Chang, Ki Kim; Chang, Oh Kim; Yong, Dongeun; Jun, Yong Choi; Young, Goo Song; Lee, Kyungwon; June, Myung Kim.

In: Infection Control and Hospital Epidemiology, Vol. 30, No. 2, 01.02.2009, p. 130-138.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Recovery of both vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus from culture of a single clinical specimen from colonized or infected patients

AU - Sang, Hoon Han

AU - Bum, Sik Chin

AU - Han, Sung Lee

AU - Su, Jin Jeong

AU - Hee, Kyung Choi

AU - Chang, Ki Kim

AU - Chang, Oh Kim

AU - Yong, Dongeun

AU - Jun, Yong Choi

AU - Young, Goo Song

AU - Lee, Kyungwon

AU - June, Myung Kim

PY - 2009/2/1

Y1 - 2009/2/1

N2 - 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 atients 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.

AB - 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 atients 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.

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