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Colonization and Transmission of High-Level Gentamicin-Resistant Enterococci in a Long-Term Care Facility

Published online by Cambridge University Press:  02 January 2015

Carol E. Chenoweth ,
Suzanne F. Bradley ,
Margaret S. Terpenning ,
Lidija T. Zarins ,
Mary A. Ramsey ,
Dennis R. Schaberg  and
Carol A. Kauffman
Carol E. Chenoweth*
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
Suzanne F. Bradley
Affiliation:
University of Michigan, Medical School and the Veterans Affairs Medical Center, Ann, Arbor, Michigan
Margaret S. Terpenning
Affiliation:
University of Michigan, Medical School and the Veterans Affairs Medical Center, Ann, Arbor, Michigan
Lidija T. Zarins
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
Mary A. Ramsey
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
Dennis R. Schaberg
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
Carol A. Kauffman
Affiliation:
Department of Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School and the Veterans Affairs Medical Center, Ann Arbor, Michigan
*
University of Michigan Hospitals, 300 North Ingalls, Room NI2B01, Ann Arbor, MI 48109-0458
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Abstract

Objectives:

To assess the prevalence of high-level gentamicin-resistant enterococcus (HGRE) colonization, transmission patterns, and spectrum of illness among residents of a long-term care facility.

Design:

Monthly surveillance for HGRE colonization of wounds, rectum, and perineum over a 1-year period.

Setting:

A Veterans Affairs long-term care facility attached to an acute-care facility.

Patients:

All 341 patients in the facility during the observation period.

Results:

Over the 1-year period, 120 patients (35.2%) were colonized with HGRE at least once, with an overall monthly colonization rate of 20± 1.5%. HGRE were isolated from rectum (12.8%), wounds (11.7%), and perineum (9.3%). Patients with the poorest functional status had the highest rate of colonization (P<0.0005). HGRE-colonized patients were more likely to be colonized with methicillin-resistant Staphylococcus aureus (51% versus 25%; P<0.0005). Seventy-four patients (21.7%) were colonized at admission or at the start of the study. Another 46 patients (13.5%) acquired HGRE during the study, including 36 who acquired HGRE while in the long-term care facility and 10 who were positive when transferred back from the acute-care hospital. Based on plasmid profiles, only two patients appeared to have isolates similar to those of current or previous roommates. Carriage of HGRE was transient in most cases. Only 20 patients were colonized for 4 or more months, and those patients usually carried different strains intermittently. Infections were infrequent, occurring in only 4.1% of total patients.

Conclusions:

In our long-term care facility, HGRE were endemic, and new acquisition of HGRE occurred frequently. However, only two patients had evidence of acquisition from a roommate, suggesting that cross-infection from a roommate was not a major route of spread of HGRE.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 11 , November 1994 , pp. 703 - 709
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994 

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