Interplay Between Patient Colonization and Environmental Contamination With Vancomycin-Resistant Enterococci and Their Association With Patient Health Outcomes in Postacute Care

Marco Cassone; Ziwei Zhu; Julia Mantey; Kristen E Gibson; Mary B Perri; Marcus J Zervos; Evan S Snitkin; Betsy Foxman; Lona Mody

doi:10.1093/ofid/ofz519

Interplay Between Patient Colonization and Environmental Contamination With Vancomycin-Resistant Enterococci and Their Association With Patient Health Outcomes in Postacute Care

Open Forum Infect Dis. 2019 Dec 11;7(1):ofz519. doi: 10.1093/ofid/ofz519. eCollection 2020 Jan.

Authors

Marco Cassone¹, Ziwei Zhu², Julia Mantey¹, Kristen E Gibson¹, Mary B Perri³, Marcus J Zervos³, Evan S Snitkin⁴, Betsy Foxman^{2

1}, Lona Mody^{1

5}

Affiliations

¹ Division of Geriatrics and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
² University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
³ Henry Ford Health System, Detroit, Michigan, USA.
⁴ Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
⁵ Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.

Abstract

Background: The clinical utility of patient and environmental surveillance screening for vancomycin-resistant enterococci (VRE) in the postacute care setting has not been definitively clarified. We assessed the longitudinal relationship between patient colonization and room contamination, and we established their association with unfavorable health outcomes.

Methods: Four hundred sixty-three postacute care patients were followed longitudinally from enrollment to discharge for up to 6 months. Multiple body and environmental sites were sampled at regular intervals to establish correlation between environmental contamination and patient colonization and with longer than expected stay, unplanned hospitalization, and infections adjusting for sex, age, race, Charlson's comorbidity index, and physical self-maintenance score.

Results: New VRE acquisition was more likely in patients residing in contaminated rooms (multivariable odds ratio [OR] = 3.75; 95% confidence interval [CI], 1.98-7.11) and vice versa (OR = 3.99; 95% CI, 2.16-7.51). New acquisition and new contamination were associated with increased length of stay (OR = 4.36, 95% CI = 1.86-10.2 and OR = 4.61, 95% CI = 1.92-11.0, respectively) and hospitalization (OR = 2.42, 95% CI = 1.39-4.22 and OR = 2.80, 95% CI = 1.52-5.12). New-onset infections were more common with higher VRE burdens (15% in the absence of VRE, 20% when after VRE isolation only on the patient or only in the room, and 29% after VRE isolation in both the patient and the room).

Conclusions: Room contamination with VRE is a risk factor for patient colonization, and both are associated with future adverse health outcomes in our postacute care patients. Further research is warranted to establish whether VRE screening may contribute to better understanding of risk assessment and adverse outcome prevention in postacute care.

Keywords: contamination; Enterococcus; health outcome; nursing home; postacute.

Abstract

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