Enteric Carriage of Vancomycin-ResistantEnterococcus faeciumin Patients Tested forClostridium difficile

Abstract

Objective: To identify independent risk factors for enteric carriage of vancomycin-resistantEnterococcus faecium(VREF) in hospitalized patients tested forClostridium difficiletoxin.Design: Retrospective case-cohort study.Setting: Tertiary-care teaching hospital.Patients: Convenience sample of 215 adult inpatients who had stool tested forC difficilebetween January 29 and February 25,1996.Results: 41 (19%) of 215 patients had enteric carriage of VREF. Five independent risk factors for enteric VREF were identified: history of priorC difficile(odds ratio [OR], 15.21; 95% confidence interval [CI₉₅], 3.30-70.10;P<.001), parenteral treatment with vancomycin for ≥5 days (OR, 4.06; CI₉₅, 1.54-10.73;P=.005), treatment with antimicrobials effective against gram-negative organisms (OR, 3.44; CI₉₅, 1.20-9.87;P=.021), admission from another institution (OR, 2.95; CI₉₅, 1.21-7.18;P=.017), and age >60 years (OR 2.57; CI₉₅, 1.13-5.82;P=.024). These risk factors for enteric VREF were independent of the patient's currentC difficilestatus.Conclusions: Antimicrobial exposures are the most important modifiable independent risk factors for enteric carriage of VREF in hospitalized patients tested forC difficile.