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

Adedayo Morenike Omotola, Yumeng Li, Emily T. Martin, Khaled Alshabani, Divya Yadav, Moumita Sarkar, Sudeep Dhoj Thapa, Vinod Kumar, Anjani Mahabashya, Sufian Ahmad, Ashish Bhargava, Dror Marchaim, Jason M. Pogue, Michael J. Rybak, Keith S. Kaye, Kayoko Hayakawa*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background 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. Methods 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. Results 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. Conclusions 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.

Original languageEnglish
Pages (from-to)1244-1248
Number of pages5
JournalAmerican Journal of Infection Control
Issue number12
StatePublished - Dec 2013
Externally publishedYes


  • Enterococcus faecalis
  • Vancomycin-resistant Enterococcus
  • Vancomycin-resistant Staphylococcus aureus


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