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

Jennie Johnstone; Cynthia Chen; Laura Rosella; Kwaku Adomako; Michelle E Policarpio; Freda Lam; Chatura Prematunge; Gary Garber; Ontario VRE Investigators

doi:10.1016/j.ajic.2018.05.003

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

Am J Infect Control. 2018 Nov;46(11):1266-1271. doi: 10.1016/j.ajic.2018.05.003. Epub 2018 Jun 11.

Authors

Jennie Johnstone¹, Cynthia Chen², Laura Rosella³, Kwaku Adomako⁴, Michelle E Policarpio⁴, Freda Lam⁴, Chatura Prematunge⁴, Gary Garber⁵; Ontario VRE Investigators

Collaborators

Ontario VRE Investigators:
Gerald A Evans⁶, Michael Gardam⁷, Susy Hota⁸, Michael John⁹, Kevin Katz¹⁰, Camille Lemieux¹¹, Allison McGeer¹², Dominik Mertz¹³, Matthew P Muller¹⁴, Virginia Roth¹⁵, Kathryn N Suh¹⁵, Mary Vearncombe¹⁶

Affiliations

¹ Public Health Ontario, Toronto, ON, Canada; St. Joseph's Health Center, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].
² Public Health Ontario, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
³ Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
⁴ Public Health Ontario, Toronto, ON, Canada.
⁵ Public Health Ontario, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ Public Health Ontario, Toronto, ON, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada; Kingston General Hospital, Kingston, ON, Canada.
⁷ University Health Network, Toronto, ON, Canada.
⁸ University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁹ London Health Sciences Center, London, ON, Canada.
¹⁰ Public Health Ontario, Toronto, ON, Canada; North York Hospital, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada.
¹¹ University Health Network, Toronto, ON, Canada; Department of Family and Community Medicine University of Toronto, Toronto, ON, Canada.
¹² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada; Sinai Health System, Toronto, ON, Canada.
¹³ Department of Medicine, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada.
¹⁴ Department of Medicine, University of Toronto, Toronto, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada.
¹⁵ Department of Medicine, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada.
¹⁶ Department of Laboratory Medicine and Pathobiology, University of Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

PMID: 29903421
DOI: 10.1016/j.ajic.2018.05.003

Abstract

Background: Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia.

Methods: 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).

Results: 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]).

Conclusions: 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.

Keywords: Bacteremia; Risk factors; VRE; Vancomycin-resistant Enterococcus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Anti-Bacterial Agents / pharmacology
Bacteremia / epidemiology*
Bacteremia / microbiology*
Case-Control Studies
Female
Gram-Positive Bacterial Infections / microbiology*
Humans
Male
Middle Aged
Odds Ratio
Ontario / epidemiology
Risk Factors
Vancomycin / pharmacology*
Vancomycin-Resistant Enterococci*

Substances

Anti-Bacterial Agents
Vancomycin