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A Matched Case-Control Study

Roman Pallares, MD; Miquel Pujol, MD; Carmen Peña, MD; Javier Ariza, MD; Rogelio Martin, MD; Francisco Gudiol, MD

Arch Intern Med. 1993;153(13):1581-1586.

Abstract
Background
Nosocomial enterococcal infections have increased in various institutions, and patients with these infections had often been treated with cephalosporins during the previous weeks. The objective of this study was to determine whether the use of second- and thirdgeneration cephalosporins is a risk factor for nosocomial enterococcal bacteremia (NEB), by means of a matched case-control study design.

Methods
Two hundred seven cases of NEB were studied. A control was matched to each case by sex, age (± 10 years), date of admission (±2 years), hospital service, days of hospitalization, primary diagnosis, and operative procedures.

Results
One hundred fifty-six cases had an appropriate matched control. The univariate analysis of unmatched variables showed that the presence of a urinary catheter (odds ratio [OR], 3.8), mechanical ventilation (OR=2.6), and cephalosporin use (OR=5.1) were associated with NEB. Using a conditional logistic regression model, cephalosporin use (adjusted OR=4.8, 95% confidence interval, 2.3 to 9.8) and urinary catheter use (adjusted OR=3.6, 95% confidence interval, 1.7 to 7.4) remained significantly associated with NEB after controlling for other unmatched variables.

Conclusions
These data show that the use of secondand third-generation cephalosporins may be a major risk factor for NEB. It may explain, at least partially, the steadily increasing number of enterococcal infections observed in some hospitals.

(Arch Intern Med. 1993;153:1581-1586)

Author Affiliations
From the Infectious Diseases Service (Drs Pallares, Pujol, Peña, Ariza, and Gudiol) and Microbiology Service (Dr Martin), Bellvitge Hospital, University of Barcelona (Spain).

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