Is Vancomycin Resistance in Enterococci Predictive of Inferior Outcome of Enterococcal Bacteremia?

Krčméry, V.; Bilikova, E.; Svetlansky, I.; Kovacicova, G.

doi:10.1086/319606

Cited by 9 publications

(4 citation statements)

References 1 publication

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“…Invasive VRE infections have been associated with high morbidity and mortality rates [1][2][3][4]. Previous studies have attributed the higher crude mortality rate observed in patients infected with VRE to the underlying severity of illness [28,39]. In the present study, prolonged hospitalisation and high crude mortality rates were related to VRE isolation in univariate analyses.…”

Section: Discussionsupporting

confidence: 48%

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Risk-factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci

Sakka¹,

Tsiodras²,

Galani³

et al. 2008

Clinical Microbiology and Infection

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Vancomycin-resistant enterococci (VRE) have emerged as significant nosocomial pathogens. A hospital-wide prevalence study was performed to identify cases with VRE faecal colonisation. A case-control study using two randomly selected VRE-negative controls for each positive case was performed to assess risk-factors for VRE colonisation by univariate and multivariate analysis. VRE faecal colonisation was documented in 53 (14.3%) of 370 patients screened. Previous exposure to anti-anaerobic agents, as well as quinolones, was associated with VRE colonisation (p <0.05). The presence of an invasive device (OR 4.8, p 0.003) and the duration of any antimicrobial treatment before VRE isolation (OR 1.2, p <0.001) predicted VRE colonisation in multivariate models. The crude mortality rate for patients with VRE colonisation was 24.5%, but VRE colonisation was not an independent predictor of mortality in these patients. These results suggest that an active surveillance programme focusing on specific patient groups may help in the identification of VRE-colonised patients. Promptly implemented infection control strategies targeting these groups should help to combat the rising incidence of VRE.

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Section: Discussionsupporting

confidence: 48%

“…A meta-analysis of ten studies revealed a possible role of quinolones in the nosocomial epidemiology of VRE [38]. Other studies have demonstrated the importance of the duration of exposure to quinolones [15] and ⁄ or their use as a prophylaxis regimen [39].…”

Section: Discussionmentioning

confidence: 99%

Risk-factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci

Sakka¹,

Tsiodras²,

Galani³

et al. 2008

Clinical Microbiology and Infection

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“…For VRE, most analyses evaluating attributable mortality rates have been retrospective with different study designs. In nine of the 15 studies listed in Table 2, no differences in clinical outcome were found between patients infected with VRE and patients infected with vancomycin‐susceptible enterococci (VSE) [10,18,36,43,44,50], whereas negative impacts on survival in patients with VRE bacteraemia were found in six studies [5,34,45,49]. The small sample sizes, choice of comparators and differences in matching criteria may explain this discrepancy.…”

Section: Discussionmentioning

confidence: 99%

“…Enterococci harbouring vanC genes, such as E. flavescens and E. gallinarum , are intrinsically resistant to low levels of vancomycin (MIC values of 8–16 mg/L). Remarkably, vancomycin resistance is more common in E. faecium than in E. faecalis [5,10,11].…”

Section: Introductionmentioning

confidence: 99%

Vancomycin-resistant enterococci: consequences for therapy and infection control

Mascini

Bonten

2005

Clinical Microbiology and Infection

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Vancomycin-resistant enterococci (VRE) have emerged as important nosocomial pathogens, initially in the USA, but now also in Europe, where hospital outbreaks are being reported with increasing frequency, although the incidence of VRE infections remains extremely low in most European countries. The recently demonstrated in-human transmission of vancomycin resistance from VRE to methicillin-resistant Staphylococcus aureus (MRSA) in two American patients underscores the potential danger of a coexisting reservoir of both pathogens. As MRSA is already endemic in many European hospital settings, prevention of endemicity with VRE seems relevant, but should be balanced against the costs associated with the implementation of effective strategies. The presence of a large community reservoir of VRE in Europe could hamper the feasibility of infection control strategies. Although the prevalence of colonisation amongst healthy subjects has apparently decreased after the ban on avoparcin use in the agricultural industry, a large proportion of admitted patients are still potential sources of VRE transmission. With no risk profile available to identify these carriers, effective screening, followed by barrier precautions for carriers, seems to be impossible. Recent studies, however, have suggested that hospital outbreaks are almost exclusively caused by specific genogroups of VRE that can be characterised phenotypically and genotypically (e.g., co-resistance to ampicillin and the presence of the variant esp gene). Based on our own experience, we propose that VRE infection control programmes should be restricted to patients colonised with these VRE strains. If such a strain is cultured from a clinical sample, surveillance amongst contact patients is recommended and barrier precautions should be implemented in the case of documented spread.

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Clinical Aspects of Multi-Drug Resistant Enterococci

Contreras¹,

Arias

2011

Antibiotic Discovery and Development

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Is Vancomycin Resistance in Enterococci Predictive of Inferior Outcome of Enterococcal Bacteremia?

Cited by 9 publications

References 1 publication

Risk-factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci

Risk-factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci

Vancomycin-resistant enterococci: consequences for therapy and infection control

Clinical Aspects of Multi-Drug Resistant Enterococci

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