Determinants of Vancomycin Resistance and Mortality Rates in Enterococcal Bacteremia: A Prospective Multicenter Study

Vergis, Emanuel N.; Hayden, Mary K.; Chow, Joseph W.; Snydman, David R.; Zervos, Marcus J.; Linden, Peter K.; Wagener, Marilyn M.; Schmitt, Barbara; Muder, Robert R.

doi:10.7326/0003-4819-135-7-200110020-00007

Cited by 283 publications

(199 citation statements)

References 45 publications

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“…The high mortality associated with VRE infection in neutropenic hosts has been noted by us and others (D Poutsiaka, in press). 21,35,36 One potential reason for our observed increased mortality in persons with VRE BSI is the lack of adequate therapy during the study period, since the introduction of quinupristin-dalfopristin, linezolid and daptomycin occurred either after or toward the end of the study period. However, it is also possible that, as in recipients of liver transplantation, VRE BSI is a marker for a debilitated host and not a direct contributor to death.…”

Section: Discussionmentioning

confidence: 99%

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

Poutsiaka

Price

Ucuzian

et al. 2007

Bone Marrow Transplant

182

149

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Blood stream infection (BSI) is a serious complication of hematopoietic stem cell transplantation (HSCT). The aim of this retrospective cohort analysis was to describe BSI after HSCT, and to assess the predictors and outcomes of BSI after HSCT using multivariable modeling. Of the 243 subjects transplanted, 56% received allogeneic HSCT and 106 (43.6%) developed BSI. Of the 185 isolates, 68% were Gram-positive cocci, 21% were Gram-negative bacilli (GNR) and 11% were fungi. Type of allogeneic HSCT was an independent risk factor for BSI (hazard ratio (HR) 3.26, 95% confidence interval (CI) 1.50, 7.07, P ¼ 0.01), as was the degree of HLA matching (HR 1.84, 95% CI 1.00, 3.37, P ¼ 0.05). BSI was a significant independent predictor of mortality after HSCT (HR 1.79, 95% CI 1.18, 2.73, P ¼ 0.007), after adjusting for acute graft-versus-host disease (GVHD) and allogeneic HSCT (both predicting death p3 months after HSCT). In contrast to the effects of acute GVHD and allogeneic HSCT, the effect of BSI was evident throughout the post-HSCT period. GNR BSI and vancomycin-resistant enterococcal BSI also were significantly associated with death. We concluded that BSI is a common complication of HSCT associated with increased mortality throughout the post-HSCT period.

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Section: Discussionmentioning

confidence: 99%

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

Poutsiaka

Price

Ucuzian

et al. 2007

Bone Marrow Transplant

182

149

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“…In this regard, Sing's investigation in India showed 40% resistance to this antibiotic in Enterococci (18). In another study in India, the resistance to aminoglycosides has been reported as 37% (19). Among the 120 Enterococcal isolates in this study, 30 isolates were ciprofloxacinresistant (25%), while the level of resistance to this antibiotic was higher in E. faecium compared to E. faecalis (80% vs. 10.5%).…”

Section: Discussionmentioning

confidence: 47%

The Antibacterial Effect of Aqueous Extract of Garlic against Resistant Enterococci

Moghadam¹,

Moghadam²

2016

mljgoums

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Background and Objective: Enterococci are relatively nonvirulent bacteria that rarely cause disease. Antimicrobial treatment of Enterococci is often challenging due to their antibiotic resistance. This study aimed to investigate the antibacterial activity of aqueous extract of garlic against Enterococcal isolates.Methods: In this descriptive study, 120 Enterococcus isolates including 70 multidrugresistant isolates were collected from hospitals of Babol, Iran. Isolates' susceptibility to different antibiotics and the antibacterial activity of garlic extract were assessed using methods of minimum inhibitory concentration (MIC) measurement. The experiments were performed according to the Clinical & Laboratory Standards Institute guidelines, using Tryptic soy broth medium and disc diffusion method.Results: Among the 120 Enterococcal isolates, 95 (79.2%) and 25 isolates (20.8%) were E. faecalis and E. faecium, respectively. Of the all Enterococcal isolates, the highest resistance was to erythromycin (95.8%), tetracycline (88.3%) and ampicillin (65.8%). While, the minimal level of resistance was to chloramphenicol (6.8%), vancomycin (20%) and ciprofloxacin (25%). Also, 53.3% of Enterococcal isolates showed simultaneous resistance to at least three antibiotics (tetracycline, erythromycin and ampicillin). Such resistance in E. faecium isolates was higher compared to E.faecalis (68% vs. 55.7%). The range of antibacterial activity of garlic extract against isolated Enterococci was determined by growth inhibition zone of 16.8 ± 1.8 mm and MIC of between 4 to 32 mg/ml.Conclusion: This study indicates the clear anti-enterococcal effect of aqueous extract of garlic and confirms the use of garlic in treatments by medicinal plants.

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“…In a prospective, multicenter, observational study of more than 400 patients with enterococcal bacteremia, we showed there was a twofold increased risk for mortality, independent of severity of illness or other factors, 2 for patients with VRE bacteremia compared with patients with VSE bacteremia. 2 We also showed that early therapy with an agent directed against VRE was associated with a better outcome compared with those initially treated with an inactive agent. 2 These data underscore the need for early identification and treatment of VRE infection.…”

Section: Commentsmentioning

confidence: 85%

Vancomycin-resistant enterococcal infections: Cause for concern?

Snydman¹

2003

Liver Transplantation

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Objectives: To determine the economic and clinical outcomes associated with infection with vancomycin-resistant Enterococcus (VRE) and to compare these outcomes to those associated with infection with vancomycin-sensitive Enterococcus (VSE CommentsThe group at John's Hopkins University assessed economic and clinical outcomes associated with infection caused by vancomycin-resistant enterococci (VRE) and compared them with infections associated with vancomycin-sensitive enterococci (VSE) in a 3-month prospective cohort study of high-risk critically ill patients. 1 Of interest to the liver transplant community is that factors shown to be associated with increased intensive care unit cost were liver transplantation and infection with either VRE or VSE. However, overall, VRE infections were associated with a mean increased cost per day of $304.There are two primary limitations to this study. One is the small number of patients studied who had invasive infection with VRE as the only pathogen. Second, the investigators included sites other than bloodstream in the analysis, which, in the context of multiple potential pathogens recovered from a given site, may have overrepresented the contribution of the enterococcus. Third, 6 of the 12 patients with invasive VRE also were infected with VSE, thus dramatically reducing the number of patients studied. Nevertheless, this is a useful study because it documents the increased cost associated with VRE infections.There is debate over the mortality or increased morbidity risk with infection caused by VRE. In a prospective, multicenter, observational study of more than 400 patients with enterococcal bacteremia, we showed there was a twofold increased risk for mortality, independent of severity of illness or other factors, 2 for patients with VRE bacteremia compared with patients with VSE bacteremia. 2 We also showed that early therapy with an agent directed against VRE was associated with a better outcome compared with those initially treated with an inactive agent. 2 These data underscore the need for early identification and treatment of VRE infection.In the liver transplantation setting, VRE usually is acquired nosocomially through either long pretransplantation hospitalization or postoperatively in the intensive care unit. Many patients remain asymptomatically colonized, and as yet, there is no good strategy for the elimination of colonization. Most infections arise in previously colonized individuals. The primary means of prevention remains good infection control. We also have shown that the environment is extremely important in the transmission of VRE from patient to patient or environment to patient. 3 Hand washing and environmental cleaning, along with identification of carriers, isolation, or appropriate precautions, remain the mainstays of prevention.Once colonized with VRE, there is no a clear assessment of risk factors for the occurrence of invasive disease in liver transplantation. Studies to assess such factors should be undertaken.Once patients have evidenc...

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Determinants of Vancomycin Resistance and Mortality Rates in Enterococcal Bacteremia: A Prospective Multicenter Study

Abstract: Vancomycin resistance is an independent predictor of death from enterococcal bacteremia. Early, effective antimicrobial therapy is associated with a significant improvement in survival.

Cited by 283 publications

References 45 publications

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

The Antibacterial Effect of Aqueous Extract of Garlic against Resistant Enterococci

Vancomycin-resistant enterococcal infections: Cause for concern?

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