Incidence, Risk Factors, and Outcomes for Enterococcus spp. Blood Stream Infections: A Population-Based Study

Billington, Emma O; Phang, Sen Han; Gregson, Dan; Pitout, Johann; Ross, Terry; Church, Deirdre L.; Laupland, Kevin B.; Parkins, Michael D.

doi:10.1016/j.ijid.2014.02.012

Cited by 156 publications

(156 citation statements)

References 36 publications

(101 reference statements)

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“…Resistance to glycopeptides and ampicillin has not been detected in E. faecalis from French and Spanish patients with bacteremia. Nevertheless, in a recent population-based study carried out in Canada, bloodstream E. faecalis isolates showed a very low prevalence of ampicillin (0.4%) and vancomycin (1.0%) resistance [13,42,44].…”

Section: Discussionmentioning

confidence: 99%

Clinical and microbiological features of bacteremia caused by Enterococcus faecalis

Ceci

Delpech

Sparo

et al. 2015

J Infect Dev Ctries

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Introduction: Enterococcus faecalis is a frequent etiologic agent of invasive infections in hospitalized patients. The aim of this study was to analyze clinical and microbiological features of bacteremia caused by E. faecalis. Methodology: Between 2011 and 2013, significant bacteremia caused by E. faecalis in hospitalized patients was studied. Patient characteristics, comorbid conditions, and 14-day mortality were recorded. Virulence genes esp, gelE, and cylA; opsonophagocytosis resistance; resistance to bactericidal effect of normal serum; beta lactamase production; and susceptibility to ampicillin, vancomycin, teicoplanin, gentamicin, and streptomycin were investigated. Results: E. faecalis strains were recovered from 33 bacteremic patients. Polymicrobial bacteremia was diagnosed in 2 patients; 10 patients died. Virulence genes were found in strains from both deceased patients and survivors. Sources of bacteremia included urinary tract infections (36.4%), vascular catheters (15.1%), abscesses (9.1%), and unknown (48.5%). Underlying diseases included cancer (30.3%), diabetes (36.4%), cirrhosis (6.1%), renal (36.4%), and chronic obstructive pulmonary disease (2.0%). Co-morbidities included alcohol use (26.1%); glucocorticoid therapy (19.0%); prior antibiotic therapy (60.6%); and central venous (21.2%), arterial (12.1%), and urinary (63.6%) catheters. Also, 57.6% of patients came from the intensive care unit (ICU); 33.3% had mechanical ventilation. Significant mortalityassociated conditions included polymicrobial bacteremia, oncological disease, APACHE II score ≥ 20, ICU stay, renal disease, central venous catheter, and mechanical ventilation. Conclusions: Outcome of patients was associated with their status and not with the presence of virulence genes in E. faecalis strains. A significant percentage of bacteremia had undetermined origin. An alternate origin may be the gastrointestinal tract, through translocation.

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Section: Discussionmentioning

confidence: 99%

Clinical and microbiological features of bacteremia caused by Enterococcus faecalis

Ceci

Delpech

Sparo

et al. 2015

J Infect Dev Ctries

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“…Samples from each model were collected at 0, 4,8,24,32,48,72, and 96 h in duplicate. Colony counts were determined by spiral plating appropriate dilutions using an automatic spiral plater (WASP; DW Scientific, West Yorkshire, England).…”

Section: Methodsmentioning

confidence: 99%

“…Often, enterococcal infections are caused by multidrug-resistant strains. For example, 0.4 to 5.2% and 70 to 92.6% of E. faecalis and E. faecium strains are resistant to ampicillin, respectively, and vancomycin resistance is present in up to 12.5% of E. faecalis and 79.7% of E. faecium (2)(3)(4). Vancomycin-resistant enterococci (VRE) are associated with increased mortality and complicated infections, such as infective endocarditis (5).…”

mentioning

confidence: 99%

β-Lactams Enhance Daptomycin Activity against Vancomycin-Resistant Enterococcus faecalis and Enterococcus faecium in In Vitro Pharmacokinetic/Pharmacodynamic Models

Smith

Barber

Raut

et al. 2015

Antimicrob Agents Chemother

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Enterococcus faecalis and Enterococcus faecium are frequently resistant to vancomycin and ␤-lactams. In enterococcal infections with reduced glycopeptide susceptibility, combination therapy is often administered. Our objective was to conduct pharmacokinetic/pharmacodynamic (PK/PD) models to evaluate ␤-lactam synergy with daptomycin (DAP) against resistant enterococci. One E. faecalis strain (R6981) and two E. faecium strains (R6370 and 8019) were evaluated. DAP MICs were obtained. All strains were evaluated for response to LL37, an antimicrobial peptide, in the presence and absence of ceftaroline (CPT), ertapenem (ERT), and ampicillin (AMP). After 96 h, in vitro models were run simulating 10 mg DAP/kg body weight/day, 600 mg CPT every 8 h (q8h), 2 g AMP q4h, and 1 g ERT q24h, both alone and in combination against all strains. DAP MICs were 2, 4, and 4 g/ml for strains R6981, R6370, and 8019, respectively. PK/PD models demonstrated bactericidal activity with DAP-CPT, DAP-AMP, and DAP-ERT combinations against strain 8019 (P < 0.001 and log 10 CFU/ml reduction of >2 compared to any single agent). Against strains R6981 and R6370, the DAP-AMP combination demonstrated enhancement against R6370 but not R6981, while the combinations of DAP-CPT and DAP-ERT were bactericidal, demonstrated enhancement, and were statistically superior to all other regimens at 96 h (P < 0.001) against both strains. CPT, ERT, and AMP similarly augmented LL37 killing against strain 8019. In strains R6981 and R6370, CPT and ERT aided LL37 more than AMP (P < 0.001). Compared to DAP alone, combination regimens provide better killing and prevent resistance. Clinical research involving DAP combinations is warranted. Enterococcus faecalis and Enterococcus faecium together account for 12% of hospital-acquired infections in the United States (1). Often, enterococcal infections are caused by multidrug-resistant strains. For example, 0.4 to 5.2% and 70 to 92.6% of E. faecalis and E. faecium strains are resistant to ampicillin, respectively, and vancomycin resistance is present in up to 12.5% of E. faecalis and 79.7% of E. faecium (2-4). Vancomycin-resistant enterococci (VRE) are associated with increased mortality and complicated infections, such as infective endocarditis (5). Treatment of VRE infections can prove problematic, as available treatment options are potentially limited by static activity and/or platelet suppression with long-term use (6-8). Daptomycin (DAP) is a bactericidal lipopeptide often used against resistant enterococci (9). Mechanistically, it binds with calcium to form a cationic moiety that disrupts membrane potential to confer its antimicrobial effects, similar to endogenous, cationic antimicrobial peptides (10, 11). DAP is frequently dosed at 6 mg/kg body weight daily, although recent clinical and in vitro data suggest improved efficacy at higher doses (7,(12)(13)(14). DAP retains excellent in vitro activity against E. faecalis and E. faecium, with MIC 50/90 values of 1/2 and 2/4 g/ml, respectively (15). Reports of DAP-nonsuscept...

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“…Enfeksiyon kontrol önlemlerinin arttırılması ve antibiyotik kullanım politikalarının belirlenmesinin direnç oranlarının azaltılmasında yararlı olacağı düşünülmektedir (14,15). Enterokoklar kan dolaşımı enfeksiyonlarında genellikle stafilokoklardan sonra izole edilen mikroorganizmalardır (16 (14,(17)(18)(19). Çalışmamızda kan kültürlerinden izole edilen enterokokların hepsi endokarditli hastalardan izole edildi ve bunlarda vankomisin direncine rastlanmadı.…”

Section: Discussionunclassified

Antimicrobial Susceptibility and Microorganisms Isolated from Blood Cultures of Hospitalized Patients in Intensive Care Units

Küçükateş¹,

Gültekin²

2016

Haseki

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ÖzAmaç: Çalışmamızda, yoğun bakım ünitelerimizde yatan hastaların kan kültürlerinde üreyen mikroorganizmaların değerlendirilmesi ve tedavi için uygun antimikrobiyal ajanların saptanması amaçlandı. Aim:The aim of this study was to evaluate microorganism growth in blood cultures of hospitalized patients in our intensive care units and to determine appropriate antimicrobial agents for treatment. Yöntemler Methods:We retrospectively investigated the blood cultures obtained from the patients hospitalized in the Coronary and Surgical Intensive Care Units at the Institute of Cardiology, İstanbul University, between July 2013 and December 2014. All microorganisms were identified using the conventional methods.Results: A total of 1034 blood cultures were obtained from 324 patients. Microbial growth was detected in 174 (16.8%) blood cultures of 68 patients. Among all microbial growth, 113 (58.55%) were gram-positive bacteria, 69 (35.75%) were gram-negative rods and 11 (5.7%) were fungi. Staphylococcus aureus was the most frequent microorganism (48; 24.87%), followed by coagulasenegative Staphylococci (35;18,13%), Enterococcus spp. (30;15,54%), Stenotrophomonas maltophilia, Escherichia coli, and Pseudomonas spp. 60.4% of Staphylococcus aureus were methicillin-resistant and 65.7% of coagulase-negative Staphylococci were also methicillinresistant. All Staphylococci and Enterococci were not resistant to vancomycin, teicoplanin and tigecycline. All the gram-negative rods were susceptible to colistin and tigecycline, followed by imipenem (71.6%) and meropenem (70.7%). Conclusions:We assume that infection control measures must be increased due to high antibiotic resistance and besides, antibiotic policies should be improved.Keywords: Blood cultures, intensive care unit, antimicrobial resistance Abs tractYa z›fl maAd re si/Ad dressforCor res pon den ce:Emine Küçükateş

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Incidence, Risk Factors, and Outcomes for Enterococcus spp. Blood Stream Infections: A Population-Based Study

Cited by 156 publications

References 36 publications

Clinical and microbiological features of bacteremia caused by Enterococcus faecalis

Clinical and microbiological features of bacteremia caused by Enterococcus faecalis

β-Lactams Enhance Daptomycin Activity against Vancomycin-Resistant Enterococcus faecalis and Enterococcus faecium in In Vitro Pharmacokinetic/Pharmacodynamic Models

Antimicrobial Susceptibility and Microorganisms Isolated from Blood Cultures of Hospitalized Patients in Intensive Care Units

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