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

• Published in: American journal of infection control 2018-11, Vol.46 (11), p.1266-1271
• Main Authors: Johnstone, Jennie, Chen, Cynthia, Rosella, Laura, Adomako, Kwaku, Policarpio, Michelle E., Lam, Freda, Prematunge, Chatura, Garber, Gary, Evans, Gerald A., Gardam, Michael, Hota, Susy, John, Michael, Katz, Kevin, Lemieux, Camille, McGeer, Allison, Mertz, Dominik, Muller, Matthew P., Roth, Virginia, Suh, Kathryn N., Vearncombe, Mary
• Format: Article
• Language: English
• Subjects: Bacteremia; Risk factors; Vancomycin-resistant Enterococcus; VRE
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2018.05.003

•Forty percent of patients with VRE bacteremia died within 30 days.•Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the intensive care unit are at highest risk of VRE bacteremia.•Larger hospital size and teaching hospitals were independent predictors of VRE bacteremia. Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia. All 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). In 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]). Patients 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.