A prospective study of the impact of colonization following hospital admission by glycopeptide-resistant Enterococci on mortality during a hospital outbreak

• Published in: American journal of infection control 2009-11, Vol.37 (9), p.746-752
• Main Authors: Hautemanière, Alexis, MD, PhD, Hunter, Paul R., MD, PhD, Diguio, Nathalie, MD, Albuisson, Elaine, MD, PhD, Hartemann, Philippe, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; Antibiotics; Carrier State - epidemiology; Carrier State - microbiology; Case-Control Studies; cross contamination; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - mortality; Disease control; Disease Outbreaks; Disease transmission; Drug resistance; Drug Resistance, Bacterial; Enterococcus - drug effects; Enterococcus - isolation & purification; Epidemics; Female; France; glycopeptide's-resistance Enterococcus; Glycopeptides - pharmacology; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Gram-Positive Bacterial Infections - mortality; Hospitalization; Hospitals; Humans; Infection Control; Infectious Disease; Male; Middle Aged; Mortality; nosocomial colonization; Nosocomial infections; Prospective Studies; Risk Factors; survey data; Survival Analysis
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2009.02.007

Background This study was designed to investigate the impact on mortality of colonization by glycopeptide-resistant Enterococci (GRE) during hospitalization. Methods Between 2004 and 2006, a hospital in Nancy, France, was subject to a GRE van A outbreak. Some 113 patients who had acquired GRE after hospital admission were matched with 113 controls. Basic demographic data, such as sex, age, principal pathology, history of surgery, and presence of associated pathology, were obtained for each case and control. Information on whether or not the case subject was still alive was obtained by searching the hospital mortality database and the civil death register and by phoning the patient's home. Statistical analysis used the Cox proportional hazards model for calculating survival function with SPSS software version 9.1 (SPSS Inc., Chicago, IL). Results The mean age was 71.2 in the GRE+ group and 70.8 in the control group ( P = .80). There was a significant difference between the groups for severity status health ( P = .035). The mortality rate was 30.1% in the case group and 19.5% in the control group. Single predictor variable analysis showed a hazard ratio of death in the case group of 4.61 (95% confidence interval [CI]: 2.58-8.28], P = 2 × 10-7 ). The final Cox regression model with multiple predictor variables showed that only GRE presence (OR, 1.63 [95% CI: 1.04-2.57], P = .035) and severity of comorbidity ( P = .013) were independently significant predictors of mortality. Conclusion This study shows that the GRE acquisition has a poor prognosis and that this is independent of the other prognostic factors such as age and severity of underlying disease. Survival in GRE+ patients was significantly shorter.