Epidemiology of vancomycin-resistant enterococcus faecalis: A case-case-control study

Kayoko Hayakawa, Dror Marchaim, Mohan Palla, Uma Mahesh Gudur, Harish Pulluru, Pradeep Bathina, Khaled Alshabani, Aditya Govindavarjhulla, Ashwini Mallad, Deepika Reddy Abbadi, Deepti Chowdary, Hari Kakarlapudi, Harish Guddati, Manoj Das, Naveen Kannekanti, Praveen Vemuri, Rajiv Doddamani, Venkat Ram Rakesh Mundra, Raviteja Reddy Guddeti, Rohan PolicherlaSarika Bai, Sharan Lohithaswa, Shiva Prasad Shashidharan, Sowmya Chidurala, Sreelatha Diviti, Krishna Sukayogula, Melwin Joseph, Jason M. Pogue, Paul R. Lephart, Emily T. Martin, Michael J. Rybak, Keith S. Kaye

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Although much is known about vancomycin-resistant (VR) Enterococcus faecium, little is known about the epidemiology of VR Enterococcus faecalis. The predilection of VR E. faecalis to transfer the vancomycin resistance determinant to Staphylococcus aureus is much greater than that of VR E. faecium. The epidemiology of VR E. faecalis has important implications regarding the emergence of vancomycin-resistant S. aureus (VRSA); 8 of 13 reported VRSA cases have been from Michigan. A retrospective case-case-control study was conducted at the Detroit Medical Center, located in southeastern Michigan. Unique patients with VR E. faecalis infection were matched to patients with strains of vancomycin-susceptible (VS) E. faecalis and to uninfected controls at a 1:1:1 ratio. Five hundred thirty-two VR E. faecalis cases were identified and were matched to 532 VS E. faecalis cases and 532 uninfected controls. The overall mean age of the study cohort (n = 1,596) was 63.0 ± 17.4 years, and 747 (46.8%) individuals were male. Independent predictors for the isolation of VR E. faecalis (but not VS E. faecalis) compared to uninfected controls were an age of ≥65 years, nonhome residence, diabetes mellitus, peripheral vascular disease, exposure to cephalosporins and fluoroquinolones in the prior 3 months, and immunosuppressive status. Invasive procedures and/or surgery, chronic skin ulcers, and indwelling devices were risk factors for both VR E. faecalis and VS E. faecalis isolation. Cephalosporin and fluoroquinolone exposures were unique, independent predictors for isolation of VR E. faecalis. A majority of case patients had VR E. faecalis present at the time of admission. Control of VR E. faecalis, and ultimately VRSA, will likely require regional efforts focusing on infection prevention and antimicrobial stewardship.

Original languageEnglish (US)
Pages (from-to)49-55
Number of pages7
JournalAntimicrobial agents and chemotherapy
Issue number1
StatePublished - Jan 2013

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases


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