Table 1.
Bivariate analysis of risk factors and outcomes for isolation of VR E. faecalis (VREF) and VS E. faecalis (VSEF), Detroit Medical Center, 2008–2009a
| Variable | Value for group |
VREF cases vs uninfected controls |
VSEF cases vs uninfected controls |
||||
|---|---|---|---|---|---|---|---|
| VREF cases (n = 532) | VSEF cases (n = 532) | Uninfected controls (n = 532) | OR (95% CI) | P value | OR (95% CI) | P value | |
| Demographics | |||||||
| Age (yr) (mean [SD]) | 66.0 (16.5) | 62.4 (18.1) | 60.6 (17.2) | NA | 0.001 | NA | 0.108 |
| No. (%) of males | 241 (45.3) | 259 (48.7) | 247 (46.4) | 0.95 (0.75–1.22) | 0.707 | 1.09 (0.86–1.38) | 0.472 |
| No. (%) of African-Americans | 417 (78.4) | 399 (75.1) | 373 (70.1) | 1.8 (1.30–2.50) | 0.001 | 1.39 (1.02–1.90) | 0.036 |
| No. (%) of individuals in nonhome residence | 265 (50.2) | 143 (27.1) | 93 (17.6) | 5.05 (3.63–7.03) | <0.001 | 1.82 (1.34–2.48) | <0.001 |
| Acute and chronic conditions on admission | |||||||
| No. (%) of individuals with condition | |||||||
| Dependent functional status | 382 (72.8) | 311 (58.6) | 219 (41.2) | 3.75 (2.81–4.99) | <0.001 | 2.06 (1.59–2.66) | <0.001 |
| Impaired consciousness | 226 (43) | 169 (31.8) | 101 (19) | 3.23 (2.40–4.36) | <0.001 | 2 (1.50–2.68) | <0.001 |
| Rapidly fatal McCabe score | 84 (16.5) | 42 (7.9) | 48 (9.1) | 2.18 (1.45–3.29) | <0.001 | 0.85 (0.53–1.35) | 0.481 |
| Cerebrovascular accident | 148 (27.8) | 145 (27.3) | 73 (13.7) | 2.5 (1.80–3.47) | <0.001 | 2.47 (1.77–3.44) | <0.001 |
| COPD | 136 (25.6) | 72 (13.6) | 98 (18.5) | 1.49 (1.12–1.99) | 0.006 | 0.71 (0.51–0.98) | 0.035 |
| Congestive heart failure | 222 (41.7) | 143 (27.1) | 116 (21.8) | 2.80 (2.08–3.77) | <0.001 | 1.34 (1.01–1.78) | 0.045 |
| Diabetes mellitus | 281 (52.8) | 209 (39.5) | 165 (31.1) | 2.63 (2–3.46) | <0.001 | 1.48 (1.14–1.92) | 0.003 |
| Dementia | 171 (32.1) | 84 (15.9) | 43 (8.1) | 5.57 (3.73–8.33) | <0.001 | 2.08 (1.41–3.06) | <0.001 |
| Chronic skin ulcer | 258 (48.9) | 128 (24.2) | 45 (8.5) | 11.14 (7.13–17.41) | <0.001 | 3.44 (2.35–5.04) | <0.001 |
| Peripheral vascular disease | 175 (32.9) | 82 (15.5) | 57 (10.7) | 4.58 (3.14–6.67) | <0.001 | 1.58 (1.08–2.32) | 0.019 |
| Peptic ulcer disease | 159 (29.9) | 56 (10.6) | 58 (10.9) | 3.3 (2.35–4.62) | <0.001 | 0.96 (0.65–1.42) | 0.842 |
| Any liver disease | 85 (16) | 69 (13) | 40 (7.5) | 2.29 (1.54–3.4) | <0.001 | 1.91 (1.24–2.92) | 0.003 |
| Any renal disease | 253 (47.6) | 168 (31.8) | 136 (25.7) | 2.68 (2.03–3.54) | <0.001 | 1.37 (1.04–1.80) | 0.026 |
| Active malignant disease | 52 (9.8) | 72 (13.6) | 56 (10.5) | 0.91 (0.58–1.4) | 0.655 | 1.43 (0.94–2.18) | 0.093 |
| Immunosuppressive stateb | 196 (36.8) | 109 (20.6) | 89 (16.8) | 2.98 (2.18–4.07) | <0.001 | 1.29 (0.94–1.77) | 0.113 |
| Charlson's weighted index of comorbidity (median [IQR]) | 5 (3–7) | 3 (1–5) | 2 (1–5) | NA | <0.001 | NA | <0.001 |
| No. (%) of individuals with exposure to health care settings and environments before VRE isolation | |||||||
| Chronic hemodialysis | 89 (16.8) | 51 (9.6) | 60 (11.3) | 1.68 (1.16–2.44) | 0.006 | 0.8 (0.52–1.21) | 0.288 |
| Permanent devicesc | 373 (70.5) | 243 (45.9) | 113 (21.2) | 8.25 (5.84–11.66) | <0.001 | 3.15 (2.36–4.2) | <0.001 |
| Hospitalized in the past 3 months | 400 (76) | 267 (50.4) | 226 (42.6) | 4.18 (3.12–5.61) | <0.001 | 1.37 (1.07–1.75) | 0.012 |
| Surgery or invasive procedured in the past 6 months | 423 (80) | 276 (52.1) | 197 (37.2) | 7.05 (5–9.95) | <0.001 | 1.91 (1.48–2.47) | <0.001 |
| ICU stay in the past 3 months | 194 (37.2) | 184 (34.7) | 125 (23.7) | 2.92 (2.0–4.26) | <0.001 | 2.06 (1.49–2.85) | <0.001 |
| Microbiology | |||||||
| No. (%) of individuals with cocolonization with MRSAe | 85 (16.0) | 36 (6.8) | 9 (1.7) | 10.5 (5.08–21.68) | <0.001 | 4.38 (2.03–9.43) | <0.001 |
| No. (%) of individuals with antimicrobial exposure within 3 months before VRE isolation | |||||||
| Any antibiotics | 410 (78.7) | 187 (35.3) | 180 (34.1) | 8.93 (6.08–13.11) | <0.001 | 1.07 (0.82–1.40) | 0.628 |
| Penicillinsf | 171 (33.3) | 29 (5.5) | 40 (7.6) | 6.96 (4.45–10.87) | <0.001 | 0.68 (0.40–1.15) | 0.148 |
| Ampicillin | 56 (11.1) | 2 (0.4) | 7 (1.3) | 9.33 (4.02–21.66) | <0.001 | 0.29 (0.06–1.38) | 0.118 |
| Ampicillin-sulbactam | 50 (9.9) | 12 (2.3) | 18 (3.4) | 3.46 (1.87–6.42) | <0.001 | 0.65 (0.30–1.38) | 0.261 |
| Piperacillin-tazobactam | 63 (12.5) | 14 (2.7) | 12 (2.3) | 9.67 (4.17–22.40) | <0.001 | 1.17 (0.54–2.52) | 0.696 |
| Amoxicillin | 28 (5.5) | 0 | 1 (0.2) | 27.0 (3.67–198.68) | 0.001 | 0.00 | 0.986 |
| Amoxicillin-clavulanate | 5 (1) | 3 (0.6) | 5 (0.9) | 1 (0.29–3.45) | 1 | 0.6 (0.14–2.51) | 0.484 |
| Cephalosporins | 276 (55.6) | 99 (18.7) | 77 (14.6) | 7.09 (4.93–10.21) | <0.001 | 1.4 (0.99–1.98) | 0.057 |
| Cefepime | 195 (38.5) | 42 (7.9) | 42 (8) | 9.61 (5.92–15.62) | <0.001 | 1 (0.63–1.58) | <0.001 |
| Ceftriaxone | 125 (24.7) | 44 (8.3) | 35 (6.6) | 3.90 (2.63–5.79) | <0.001 | 1.3 (0.81–2.09) | 0.280 |
| Cefazolin | 58 (11.4) | 13 (2.5) | 12 (2.3) | 6.22 (3.08–12.58) | <0.001 | 1.08 (0.49–2.37) | 0.842 |
| Carbapenem | 32 (6.2) | 19 (3.6) | 22 (4.2) | 1.667 (0.88–3.16) | 0.118 | 0.85 (0.45–1.62) | 0.623 |
| Vancomycin | 252 (49) | 77 (14.5) | 85 (16.1) | 5.69 (4–8.12) | <0.001 | 0.97 (0.62–1.52) | 0.909 |
| Daptomycin | 6 (1.2) | 5 (0.9) | 8 (1.5) | 0.75 (0.26–2.16) | 0.594 | 0.63 (0.2–1.91) | 0.410 |
| Linezolid | 26 (5) | 7 (1.3) | 11 (2.1) | 2.78 (1.3–5.95) | 0.009 | 0.64 (0.25–1.64) | 0.350 |
| Fluoroquinolones | 134 (26.1) | 42 (7.9) | 43 (8.1) | 4.6 (2.99–7.09) | <0.001 | 0.97 (0.62–1.52) | 0.909 |
| Trimethoprim-sulfamethoxazole | 57 (11.1) | 22 (4.2) | 19 (3.6) | 3.24 (1.88–5.57) | <0.001 | 1.16 (0.63–2.14) | 0.640 |
| Metronidazole | 71 (13.8) | 27 (5.1) | 31 (5.9) | 2.6 (1.64–4.12) | <0.001 | 0.86 (0.51–1.47) | 0.587 |
| Clindamycin | 37 (7.2) | 21 (4) | 14 (2.7) | 3 (1.56–5.77) | 0.001 | 1.5 (0.76–2.95) | 0.240 |
| Macrolides | 43 (8.3) | 13 (2.5) | 13 (2.5) | 3.9 (1.95–7.81) | <0.001 | 1 (0.43–2.31) | 1.000 |
| Aminoglycosides | 66 (12.8) | 18 (3.4) | 24 (4.5) | 3.28 (1.93–5.56) | <0.001 | 0.73 (0.38–1.39) | 0.332 |
| Tetracyclines | 30 (5.8) | 15 (2.8) | 18 (3.4) | 1.87 (1–3.5) | 0.051 | 0.83 (0.42–1.65) | 0.603 |
| Oral vancomycin | 24 (4.7) | 4 (0.8) | 5 (0.9) | 5.5 (1.9–15.95) | 0.002 | 0.80 (0.22–2.98) | 0.740 |
| Outcomes | |||||||
| No. (%) of individuals with outcome | |||||||
| In-hospital mortality | 52 (9.8) | 39 (7.4) | 35 (6.6) | 1.81 (1.06–3.08) | 0.029 | 1.12 (0.7–1.79) | 0.633 |
| 3-month mortality | 90 (18.3) | 69 (13.5) | 52 (10.1) | 2.58 (1.64–4.05) | <0.001 | 1.43 (0.97–2.1) | 0.068 |
| Functional status deterioration | 74 (15.8) | 102 (20.8) | 26 (6.8) | 2.38 (1.43–3.96) | 0.001 | 4.93 (2.77–8.75) | <0.001 |
| Dependent functional status at discharge | 377 (80.6) | 323 (65.8) | 193 (38.8) | 6.81 (4.7–9.87) | <0.001 | 3.24 (2.42–4.35) | <0.001 |
| Discharge to LTCF after being admitted from home | 84 (33.9) | 91 (23.5) | 51 (11.4) | 2.76 (1.68–4.55) | <0.001 | 2.21 (1.42–3.46) | 0.001 |
| Additional hospitalizations within 6 months following VREF/VSEF isolationg | 345 (74.5) | 288 (59.9) | 247 (50.8) | 2.86 (2.12–3.87) | <0.001 | 1.44 (1.1–1.88) | 0.008 |
| Invasive procedure or surgery within 3 months following VREF/VSEF isolationg | 276 (55.2) | 175 (33.9) | 174 (34.7) | 2.25 (1.72–2.95) | <0.001 | 1.01 (0.77–1.33) | 0.945 |
| Total length of hospital stay (days) (median [IQR]) | 11.4 (5.6–21.4) | 9.9 (4.7–22.1) | 4.2 (1.1–11.9) | NA | <0.001 | NA | <0.001 |
| Total length of hospital stay, excluding deathsh (days) (median [IQR]) | 6.6 (1.4–17.6) | 6.4 (1.8–17.0) | 2.0 (0.9–7.8) | NA | <0.001 | NA | <0.001 |
Data include percentages of patients for whom data were available, i.e., excluding the missing cases. Statistically significant data are shown in bold. Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; ICU, intensive care unit; IQR, interquartile range; LOS, length of hospital stay; LTCF, long-term care facilities; MRSA, methicillin-resistant Staphylococcus aureus; NA, data not available; OR, odds ratio; SD, standard deviation.
Includes one or more of the following: (i) neutropenia (<500 neutrophils) at time of culture, (ii) glucocorticoid/steroid use in the past month, (iii) chemotherapy in the past 3 months, (iv) radiotherapy in the past 3 months, (v) posttransplantation status, (vi) anti-TNF-α therapy in the past 3 months, and (vii) HIV infection.
Chronic or permanent devices (e.g., tracheotomies, central lines, urinary catheters, and orthopedic external fixators) that were in place at time of VREF/VSEF isolation (on admission for uninfected controls).
Includes percutaneous interventions, endoscopies, and biopsies.
Cocolonization with MRSA was defined as isolation of MRSA from any body site within 7 days before or after the isolation of VRE (for uninfected controls, MRSA colonization was defined as isolation of MRSA within 7 days before or after the admission date).
Penicillins include β-lactam–β-lactamase inhibitor combinations.
After admission for uninfected controls.
Excluding data for patients who died during hospitalization.