611 Co-colonization of Vancomycin-Resistant Enterococcus faecalis and Methicillin-Resistant Staphylococcus aureus (MRSA) at Detroit Medical Center

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Kayoko Hayakawa, MD, PhD , Detroit Medical Center, Wayne State University, Detroit, MI
Dror Marchaim, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Jason M. Pogue, PharmD , Detroit Medical Center, Wayne State University, Detroit, MI
Paul R. Lephart, PhD , Detroit Medical Center, Wayne State University, Detroit, MI
Bharath Sunkara, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Harikrishna Kotra, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Asma Hasan, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Judy Moshos, MT , Detroit Medical Center, Wayne State University, Detroit, MI
Maryann Shango, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Yashwanth Yerramalla, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Sarwan Kumar, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Vicki Collins, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Kimberley Ku, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Palaniappan Manickam, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
Sagar Mallikethi Lepakshi Reddy, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Kavyashri Kodlipet Jagadeesh, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Verma Sourabh, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Adedayo Morenike Omotola, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Dhivya Sundaramurthy, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Suchitha Bheemreddy, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Jessie Swan, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Lakisha Burton Willis, MBA , Detroit Medical Center, Wayne State University, Detroit, MI
Satyam Patel, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Rupali Krishana, BA , Detroit Medical Center, Wayne State University, Detroit, MI
Maninderpal Dhillon, BS , Detroit Medical Center, Wayne State University, Detroit, MI
Nimrit Sohal , Detroit Medical Center, Wayne State University, Detroit, MI
Hardik Doshi, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Neelu Chugh, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Miriam Levine, BA , Detroit Medical Center, Wayne State University, Detroit, MI
Victoria Yee, BS, MS , Detroit Medical Center, Wayne State University, Detroit, MI
Farah Ahmad, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Umme Suhrawardy, MBBS , Detroit Medical Center, Wayne State University, Detroit, MI
Chika Okoronkwo, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Teena Chopra, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Sorabh Dhar, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Keith S. Kaye, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI

Background: The vanA gene complex can transfer horizontally from vancomycin-resistant Enterococcus (VRE) to Staphylococcus aureus, resulting in vancomycin-resistant S. aureus (VRSA), a serious public health threat. Eleven cases of VRSA have been reported in the US, including 8 from Southeast Michigan.  Transfer VanA occurs more frequently from E. faecalis, than from E. faecium. In the Detroit area, the proportion of VRE that is E. faecalis is disproportionately high.

Objective: Describe the epidemiological characteristics and outcomes of patients co-colonized with VRE faecalis and MRSA.

Methods: Detroit Medical Center (DMC) consists of 8 hospitals and over 2,200 inpatient beds and is located in Southeastern Michigan. All unique patient cases co-colonized with VRE faecalis and MRSA (defined as isolated of MRSA within 7 days of VRE) for calendar years 2008-09 were included.

Results: Of 1525 VRE cases during the study period, 554 (36%) were VRE faecalis and 72 (13%) were co-colonized with VRE faecalis and MRSA. The mean age of the study cohort (n=72) was 6616 years, 38 (53%) were elderly (≥65 years), 45 (63%) were male, 52 (72%) were African American, 44 (61%) resided in institutions prior to admission, and 60 (83%) lacked independence with activities of daily living on admission. Twenty-nine (40%) of the VRE faecalis isolations were from urine, 20 (28%) from wounds, 19 (26%) from blood, and 4 (6%) from catheter tips. MRSA was isolated from wounds in 25 (35%) cases, sputum in 21 (29%), blood in 18 (23%), and urine in 8 (11%) cases.  In 37 (51%) patients, VRE faecalis and MRSA were isolated from the same site, 19 of which were wounds.  In 31 (43%) patients, VRE faecalis and MRSA were isolated from the same culture specimen. Forty-seven (65%) cases had a history of a recent hospitalization and 55 (76%) had had invasive procedures prior to culture.  Thirty-nine (54%) patients had diabetes, 37 (51%) had renal disease, 12 (17%) were hemodialysis  patients and 40 (56%) had chronic skin ulcer as underlying conditions. The median Charlson's score was 5 (IQR 3-8). Forty-eight cases (67%) had an indwelling central line and 63 (88%) had chronic indwelling devices prior to VRE and MRSA co-isolation. There were 60 (83%) patients who received antibiotics within 3 months of isolation, the most common of which were cephalosporins [n=41 (57%)], and glycopeptides [n=41 (57%)]. Fifteen cases (21%) died within 3 months of VRE and MRSA co-isolation; the median LOS following culture was 10 days (IQR 5-18); 40 cases (56%) were readmitted within 6 months after culture, and 50 (69%) had invasive procedures within 3 months following MRSA and VRE recovery.  

Conclusions: Patients co-colonized with VRE faecalis and MRSA were elderly, had prior healthcare exposures, frequently had indwelling device and multiple comorbid conditions.  More than half of our cohort had chronic skin ulcers.