Interplay Between Patient Colonization and Environmental Contamination With Vancomycin-Resistant Enterococci and Their Association With Patient Health Outcomes in Postacute Care.
contamination
Enterococcus
health outcome
nursing home
postacute
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
29
08
2019
accepted:
05
12
2019
entrez:
29
1
2020
pubmed:
29
1
2020
medline:
29
1
2020
Statut:
epublish
Résumé
The clinical utility of patient and environmental surveillance screening for vancomycin-resistant enterococci (VRE) in the postacute care setting has not been definitively clarified. We assessed the longitudinal relationship between patient colonization and room contamination, and we established their association with unfavorable health outcomes. Four hundred sixty-three postacute care patients were followed longitudinally from enrollment to discharge for up to 6 months. Multiple body and environmental sites were sampled at regular intervals to establish correlation between environmental contamination and patient colonization and with longer than expected stay, unplanned hospitalization, and infections adjusting for sex, age, race, Charlson's comorbidity index, and physical self-maintenance score. New VRE acquisition was more likely in patients residing in contaminated rooms (multivariable odds ratio [OR] = 3.75; 95% confidence interval [CI], 1.98-7.11) and vice versa (OR = 3.99; 95% CI, 2.16-7.51). New acquisition and new contamination were associated with increased length of stay (OR = 4.36, 95% CI = 1.86-10.2 and OR = 4.61, 95% CI = 1.92-11.0, respectively) and hospitalization (OR = 2.42, 95% CI = 1.39-4.22 and OR = 2.80, 95% CI = 1.52-5.12). New-onset infections were more common with higher VRE burdens (15% in the absence of VRE, 20% when after VRE isolation only on the patient or only in the room, and 29% after VRE isolation in both the patient and the room). Room contamination with VRE is a risk factor for patient colonization, and both are associated with future adverse health outcomes in our postacute care patients. Further research is warranted to establish whether VRE screening may contribute to better understanding of risk assessment and adverse outcome prevention in postacute care.
Sections du résumé
BACKGROUND
BACKGROUND
The clinical utility of patient and environmental surveillance screening for vancomycin-resistant enterococci (VRE) in the postacute care setting has not been definitively clarified. We assessed the longitudinal relationship between patient colonization and room contamination, and we established their association with unfavorable health outcomes.
METHODS
METHODS
Four hundred sixty-three postacute care patients were followed longitudinally from enrollment to discharge for up to 6 months. Multiple body and environmental sites were sampled at regular intervals to establish correlation between environmental contamination and patient colonization and with longer than expected stay, unplanned hospitalization, and infections adjusting for sex, age, race, Charlson's comorbidity index, and physical self-maintenance score.
RESULTS
RESULTS
New VRE acquisition was more likely in patients residing in contaminated rooms (multivariable odds ratio [OR] = 3.75; 95% confidence interval [CI], 1.98-7.11) and vice versa (OR = 3.99; 95% CI, 2.16-7.51). New acquisition and new contamination were associated with increased length of stay (OR = 4.36, 95% CI = 1.86-10.2 and OR = 4.61, 95% CI = 1.92-11.0, respectively) and hospitalization (OR = 2.42, 95% CI = 1.39-4.22 and OR = 2.80, 95% CI = 1.52-5.12). New-onset infections were more common with higher VRE burdens (15% in the absence of VRE, 20% when after VRE isolation only on the patient or only in the room, and 29% after VRE isolation in both the patient and the room).
CONCLUSIONS
CONCLUSIONS
Room contamination with VRE is a risk factor for patient colonization, and both are associated with future adverse health outcomes in our postacute care patients. Further research is warranted to establish whether VRE screening may contribute to better understanding of risk assessment and adverse outcome prevention in postacute care.
Identifiants
pubmed: 31988973
doi: 10.1093/ofid/ofz519
pii: ofz519
pmc: PMC6976341
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofz519Subventions
Organisme : NIA NIH HHS
ID : K24 AG050685
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG024824
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG041780
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
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