Exposures Associated With Clinically Important Antimicrobial Resistance Among Enterococci Isolated From Outpatient Human Stool Specimens

Due to the severity and high mortality rates of antimicrobial-resistant enterococcal infections, vancomycin resistant enterococci (VRE) in particular; it is of the utmost public health importance to prevent a transition from health care acquisition to a pocket with community exposure alone. This study was a secondary data analysis of a cross-sectional study that collected questionnaire data for known risk factors and isolated enterococci from the stools of hospital outpatients. Known risk factors for carriage of community-associated antimicrobial-resistant enterococci (CA-REC) in various settings worldwide include farm animal exposure, travel outside of the United States, hospitalization, and antimicrobial exposure. The prevalence of CA-REC in this study population was 28.2%. Results from chi-square analysis indicated a significant association with study participants who had farm animal exposure in the 6 months prior to stool collection ( p = 0.0440). No other risk factor was statistically significant. No significant collective influence of known risk factors, with gender and age, was indicated with logistic regression modeling. This study promotes positive social change by associating carriage of CA-REC with a risk factor not previously described in a U.S. community setting. Although the sample size for this analysis was small, indicating a need for further research to describe statistically significant associations between the carriage of CA-REC and risk factors, the Food and Drug Administration could scrutinize the results of this study when reevaluating the use of antimicrobials as growth promoters in food-producing animals.