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Rohde AM, Walker S, Behnke M, Eisenbeis S, Falgenhauer L, Falgenhauer JC, Häcker G, Hölzl F, Imirzalioglu C, Käding N, Kern WV, Kola A, Kramme E, Mischnik A, Peter S, Rieg S, Rupp J, Schneider C, Schwab F, Seifert H, Tacconelli E, Tobys D, Trauth J, Weber A, Xanthopoulou K, Zweigner J, Higgins PG, Gastmeier P. Vancomycin-resistant Enterococcus faecium: admission prevalence, sequence types and risk factors-a cross-sectional study in seven German university hospitals from 2014 to 2018. Clin Microbiol Infect 2022; 29:515-522. [PMID: 36481293 DOI: 10.1016/j.cmi.2022.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/11/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Assessment of vancomycin-resistant Enterococcus faecium (VREfm) prevalence upon hospital admission and analysis of risk factors for colonization. METHODS From 2014 to 2018, patients were recruited within 72 hours of admission to seven participating German university hospitals, screened for VREfm and questioned for potential risk factors (prior multidrug-resistant organism detection, current/prior antibiotic consumption, prior hospital, rehabilitation or long-term care facility stay, international travel, animal contact and proton pump inhibitor [PPI]/antacid therapy). Genotype analysis was done using cgMLST typing. Multivariable analysis was performed. RESULTS In 5 years, 265 of 17,349 included patients were colonized with VREfm (a prevalence of 1.5%). Risk factors for VREfm colonization were age (adjusted OR [aOR], 1.02; 95% CI, 1.01-1.03), previous (aOR, 2.71; 95% CI, 1.87-3.92) or current (aOR, 2.91; 95% CI, 2.60-3.24) antibiotic treatment, prior multidrug-resistant organism detection (aOR, 2.83; 95% CI, 2.21-3.63), prior stay in a long-term care facility (aOR, 2.19; 95% CI, 1.62-2.97), prior stay in a hospital (aOR, 2.91; 95% CI, 2.05-4.13) and prior consumption of PPI/antacids (aOR, 1.29; 95% CI, 1.18-1.41). Overall, the VREfm admission prevalence increased by 33% each year and 2% each year of life. 250 of 265 isolates were genotyped and 141 (53.2%) of the VREfm were the emerging ST117. Multivariable analysis showed that ST117 and non-ST117 VREfm colonized patients differed with respect to admission year and prior multidrug-resistant organism detection. DISCUSSION Age, healthcare contacts and antibiotic and PPI/antacid consumption increase the individual risk of VREfm colonization. The VREfm admission prevalence increase in Germany is mainly driven by the emergence of ST117.
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Affiliation(s)
- Anna M Rohde
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Sarah Walker
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Behnke
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simone Eisenbeis
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Linda Falgenhauer
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute of Hygiene and Environmental Medicine, Justus Liebig University, Giessen, Germany
| | - Jane C Falgenhauer
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute of Medical Microbiology, Justus Liebig University, Giessen, Germany
| | - Georg Häcker
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Florian Hölzl
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany; Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Can Imirzalioglu
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute of Medical Microbiology, Justus Liebig University, Giessen, Germany
| | - Nadja Käding
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus, Lübeck, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Freiburg, Germany
| | - Axel Kola
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Evelyn Kramme
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus, Lübeck, Germany
| | - Alexander Mischnik
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus, Lübeck, Germany
| | - Silke Peter
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Freiburg, Germany
| | - Jan Rupp
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus, Lübeck, Germany
| | - Christian Schneider
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frank Schwab
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Harald Seifert
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Evelina Tacconelli
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - David Tobys
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Janina Trauth
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Internal Medicine (Infectiology), Uniklinikum, Giessen, Germany
| | - Anna Weber
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kyriaki Xanthopoulou
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Janine Zweigner
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | - Paul G Higgins
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Petra Gastmeier
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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