Comparative epidemiology of vancomycin-resistant enterococci colonization in an acute care hospital and its affiliated intermediate- and long-term care facilities in Singapore.

Vancomycin-resistant enterococci (VRE) is an important cause of nosocomial infections in acute care hospitals (ACHs), intermediate- (ITCFs) and long-term care facilities (LTCFs). This study contemporaneously compared the epidemiology and risk factors for VRE colonization in different care settings in a healthcare network. We conducted a serial cross-sectional study in a 1700-bed ACH and its six closely-affiliated ITCFs and LTCFs in June-July, 2014-2016. Rectal swabs or stool were cultured for VRE. Multivariable logistic regression was used to assess for independent risk factors associated with VRE colonization. Of 5357 participants, 523 (9.8%) were VRE-colonized. VRE prevalence was higher in ACH (14.2%) than ITCFs (7.6%) and LTCFs (0.8%). Common risk factors between ACH and ITCFs included prior VRE carriage; a longer duration of antibiotic therapy; surgery in the preceding 90 days and presence of skin ulcer. Independent risk factors specific to ACH-admitted patients were prior MRSA carriage; a higher number of beds per room; prior proton pump inhibitors use and length of stay >14 days. For ITCFs, length of stay >14 days was inversely associated with VRE colonization. Similarities and differences in risk factors for VRE colonization were observed between healthcare settings. VRE prevention efforts should target the respective high-risk patients.