BACKGROUND The emergence of vancomycin-resistant Staphylococcus aureus (VRSA) has become a global concern for public health. The proximity of vancomycin-resistant enterococcus (VRE) and methicillin-resistant S. aureus (MRSA) is considered to be one of the foremost risk factors for the development of VRSA. This study aimed to determine the incidence, risk factors, and clinical outcomes of intestinal co-colonization with VRE and MRSA. METHODS A case-control study was conducted in 52-bed intensive care units (ICUs) of a university-affiliated hospital from September 2012 to October 2017. Active surveillance using rectal cultures for VRE were conducted at ICU admission and on a weekly basis. Weekly surveillance cultures for detection of rectal MRSA were also conducted in patients with VRE carriage. Patients with intestinal co-colonization of VRE and MRSA were compared with randomly selected control patients with VRE colonization alone (1:1). Vancomycin minimum inhibitory concentrations (MICs) for MRSA isolates were determined by the Etest. RESULTS Of the 4679 consecutive patients, 195 cases and 924 controls were detected. The median monthly incidence and duration of intestinal co-colonization with VRE and MRSA were 2.3/1000 patient-days and 7 days, respectively. The frequency of both MRSA infections and mortality attributable to MRSA were higher in the case group than in the control group: 56.9% vs. 44.1% (P = 0.011) and 8.2% vs. 1.0% (P = 0.002), respectively. Independent risk factors for intestinal co-colonization were enteral tube feeding (odds ratio [OR], 2.09; 95% confidence interval [CI] 1.32-3.32), metabolic diseases (OR, 1.75; 95% CI 1.05-2.93), male gender (OR, 1.62; 95% CI 1.06-2.50), and Charlson comorbidity index < 3 (OR, 3.61; 95% CI 1.88-6.94). All MRSA isolates from case patients were susceptible to vancomycin (MIC ≤ 2 mg/L). CONCLUSIONS Our study indicates that intestinal co-colonization of VRE and MRSA occurs commonly among patients in the ICU with MRSA endemicity, which might be associated with poor clinical outcomes.

中文翻译：

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确定重症监护病房患者肠道中耐万古霉素的肠球菌和耐甲氧西林的金黄色葡萄球菌的共集落的临床意义：一项病例对照研究。

背景技术耐万古霉素的金黄色葡萄球菌（VRSA）的出现已成为公共卫生的全球关注。耐万古霉素的肠球菌（VRE）和耐甲氧西林的金黄色葡萄球菌（MRSA）接近是发生VRSA的最重要风险因素之一。这项研究旨在确定与VRE和MRSA肠道共定殖的发生率，危险因素和临床结局。方法自2012年9月至2017年10月，在大学附属医院的52张病床的重症监护病房（ICU）中进行了病例对照研究。在ICU入院时，每周一次使用直肠培养的VRE进行主动监测。在VRE支架患者中还进行了每周一次的直肠MRSA检测监测培养。将VRE和MRSA肠道共定植的患者与随机选择的仅VRE定植的对照患者进行比较（1：1）。通过Etest测定MRSA分离株的万古霉素最低抑菌浓度（MIC）。结果在4679例连续患者中，检出195例和924例对照。与VRE和MRSA肠道共定殖的中位每月发生率和持续时间分别为2.3 / 1000患者天和7天。病例组的MRSA感染频率和归因于MRSA的死亡率均高于对照组：分别为56.9％对44.1％（P = 0.011）和8.2％对1.0％（P = 0.002）。肠道共定殖的独立危险因素是肠管饲喂（比值比[OR]为2.09； 95％置信区间[CI] 1.32-3.32），代谢性疾病（OR为1.75；95％CI 1.05-2.93），男性（OR，1.62; 95％CI 1.06-2.50）和Charlson合并症指数<3（OR，3.61; 95％CI 1.88-6.94）。病例患者的所有MRSA分离株均对万古霉素敏感（MIC≤2 mg / L）。结论我们的研究表明，VRE和MRSA的肠道共定植普遍发生在MRSA流行的ICU患者中，这可能与不良的临床预后有关。