Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
Eur J Clin Microbiol Infect Dis. 2013 Jun;32(6):815-20. doi: 10.1007/s10096-013-1814-z. Epub 2013 Jan 26.
In the majority of cases of vancomycin-resistant Staphylococcus aureus (VRSA), vancomycin-resistant Enterococcus faecalis (VR E. faecalis) served as the vanA donor to S. aureus. Previous studies that evaluated the risk factors for co-colonization with VRE and MRSA did not differentiate between VR E. faecalis and VR E. faecium. This study aimed to identify variables associated with VR E. faecalis and MRSA co-colonization. A retrospective case-control study from January 2008 to December 2009 was conducted at the Detroit Medical Center. Data were extracted from charts and pharmacy records. Unique patients co-colonized with VR E. faecalis and MRSA (defined as isolation of MRSA within 7 days of VR E. faecalis isolation) were compared with patients with VR E. faecalis who were not co-colonized with MRSA. A total of 546 patients with VR E. faecalis isolation were identified. 85 (15.6 %) VR E. faecalis patients were co-colonized with MRSA and 461 (84.4 %) VR E. faecalis patients were not co-colonized with MRSA. The mean age of the study cohort was 65.9 ± 16.4 years, 424 (77.7 %) were African-American, and 270 (49.5 %) were residing in long-term care institutions. Independent predictors of co-colonization of VR E. faecalis and MRSA were male gender, impaired consciousness, ICU stay prior to VR E. faecalis isolation, indwelling devices, and isolation of VR E. faecalis from wounds. MRSA was frequently isolated from the same culture specimen as VR E. faecalis (n = 39, 45.9 %), most commonly from wounds. This large study of patients with VR E. faecalis identified the severity of illness, indwelling devices, and chronic wounds as independent predictors of co-colonization with VR E. faecalis and MRSA.
在大多数耐万古霉素金黄色葡萄球菌（VRSA）病例中，耐万古霉素粪肠球菌（VRE）faecalis 是金黄色葡萄球菌的 vanA 供体。之前评估 VRE 和耐甲氧西林金黄色葡萄球菌（MRSA）共同定植危险因素的研究并未区分 VR E. faecalis 和 VR E. faecium。本研究旨在确定与 VR E. faecalis 和 MRSA 共同定植相关的变量。这是一项 2008 年 1 月至 2009 年 12 月在底特律医疗中心进行的回顾性病例对照研究。数据从图表和药房记录中提取。将与 MRSA 共同定植的独特患者（定义为在 VR E. faecalis 分离后 7 天内分离出 MRSA）与未与 MRSA 共同定植的 VR E. faecalis 患者进行比较。共确定了 546 例 VR E. faecalis 分离患者。85 例（15.6%）VR E. faecalis 患者与 MRSA 共同定植，461 例（84.4%）VR E. faecalis 患者未与 MRSA 共同定植。研究队列的平均年龄为 65.9±16.4 岁，424 例（77.7%）为非裔美国人，270 例（49.5%）居住在长期护理机构。VR E. faecalis 和 MRSA 共同定植的独立预测因素为男性、意识障碍、VR E. faecalis 分离前入住 ICU、留置装置以及 VR E. faecalis 从伤口分离。MRSA 经常从与 VR E. faecalis 相同的培养标本中分离（n=39，45.9%），最常见于伤口。这项对 VR E. faecalis 患者的大型研究确定了疾病严重程度、留置装置和慢性伤口是与 VR E. faecalis 和 MRSA 共同定植的独立预测因素。
