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Am J Infect Control. 2013 Dec;41(12):1244-8. doi: 10.1016/j.ajic.2013.05.025. Epub 2013 Sep 5.

Risk factors for and epidemiology of community-onset vancomycin-resistant Enterococcus faecalis in southeast Michigan.

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Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.



Given the known link between vancomycin-resistant Enterococcus faecalis (VREF) and vancomycin-resistant Staphylococcus aureus (VRSA), the recent increase in prevalence of VREF in southeast Michigan has raised concerns about the presence of a large "community" reservoir of VREF. Efforts to control its spread face some important challenges.


Patients with clinical isolates of community-onset (CO) VREF (cases) were compared with matched uninfected controls (study 1) and patients with hospital-onset (HO) VREF (study 2). Here, CO was defined as a hospital stay of ≤2 days before VRE isolation.


Independent predictors for the isolation of CO-VREF compared with uninfected controls were nonhome residence; chronic skin ulcers; previous invasive procedures/surgery; exposure to cephalosporin, penicillin, and/or vancomycin; immunosuppressive status; and the presence of indwelling devices. Independent predictors for isolation of CO-VREF compared with HO-VREF included no stay in an intensive care unit in the previous 3 months and recent hospitalization. VREF isolation from wounds and aminoglycoside exposure were inversely associated with isolation of CO-VREF.


Health care-related exposures and antimicrobial exposures are risk factors for the isolation of CO-VREF. Regional infection control practices are imperative in controlling CO-VREF, in addition to the emergence and spread of VRSA.


Enterococcus faecalis; Vancomycin-resistant Enterococcus; Vancomycin-resistant Staphylococcus aureus

[Indexed for MEDLINE]

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