Molecular Epidemiology and Risk Factors for Colonization by Vancomycin-Resistant<i>Enterococcus</i>in Patients with Hematologic Malignancies

Almyroudis, Nikolaos G.; Lesse, Alan J.; Hahn, Theresa; Samonis, George; Hazamy, Peggy Ann; Wongkittiroch, K.; Wang, Eunice S.; McCarthy, Philip L.; Wetzler, Meir; Segal, Brahm H.

doi:10.1086/659408

Cited by 22 publications

(22 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although several studies have focused on risk factors for vancomycin-resistant enterococcal infection or colonization [23,24], little is known about risk factors for BSI due to vancomycin-susceptible E. faecium .…”

Section: Discussionmentioning

confidence: 99%

Increase in Bloodstream Infection Due to Vancomycin-Susceptible Enterococcus faecium in Cancer Patients: Risk Factors, Molecular Epidemiology and Outcomes

et al. 2013

View full text Add to dashboard Cite

We conducted a prospective study to assess the risk factors, molecular epidemiology and outcome of bloodstream infection (BSI) due to Enterococcus faecium in hospitalized cancer patients. Between 2006 and 2012, a significant increase in vancomycin-susceptible E. faecium BSI was observed among cancer patients. Comparison of 54 episodes of BSI due to E. faecium with 38 episodes of BSI due to E. faecalis showed that previous use of carbapenems was the only independent risk factor for E. faecium acquisition (OR 10.24; 95% CI, 1.35-77.66). All E. faecium isolates were susceptible to glycopeptides, whereas 97% showed high-level resistance to ampicillin and ciprofloxacin. All 30 isolates available for genotyping belonged to the hospital-associated E. faecium lineages 17, 18 and 78. After 2009, most of the isolates belonged to ST117 (lineage 78). Patients with E. faecium BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with E. faecalis BSI, and time to adequate empirical antibiotic therapy was also longer in the former group. No significant differences were found between the two groups regarding early and overall case-fatality rates. Independent risk factors for overall case-fatality were current corticosteroids (OR 4.18; 95% CI, 1.34-13.01) and intensive care unit admission (OR 9.97; 95% CI, 1.96-50.63). The emergence of E. faecium among cancer patients is a concern since there are limited treatment options and it may presage the emergence of vancomycin-resistant enterococci. A rationale approach that combines infection control with antimicrobial stewardship.

show abstract

Section: Discussionmentioning

confidence: 99%

Increase in Bloodstream Infection Due to Vancomycin-Susceptible Enterococcus faecium in Cancer Patients: Risk Factors, Molecular Epidemiology and Outcomes

et al. 2013

View full text Add to dashboard Cite

show abstract

“…The molecular epidemiology analysis revealed a primarily sporadic pattern of VRE acquisition in which the majority of the patients harbored unique VRE strains. 4 Based on the inefficiency of the contact isolation and the molecular epidemiology data, a decision was made to discontinue the systematic surveillance for VRE and contact …”

mentioning

confidence: 99%

Discontinuation of Systematic Surveillance and Contact Precautions for Vancomycin-ResistantEnterococcus(VRE) and Its Impact on the Incidence of VREfaeciumBacteremia in Patients with Hematologic Malignancies

Almyroudis

Osawa

Samonis

et al. 2016

Infect. Control Hosp. Epidemiol.

Self Cite

View full text Add to dashboard Cite

OBJECTIVE To study the effect of discontinuation of systematic surveillance for vancomycin-resistant Enterococcus (VRE) and contact isolation of colonized patients on the incidence of VRE bacteremia SETTING A hematology-oncology unit with high prevalence of VRE colonization characterized by predominantly sporadic molecular epidemiology PARTICIPANTS Inpatients with hematologic malignancies and recipients of hematopoietic stem cell transplantation METHODS The incidence of VRE bacteremia was measured prospectively during 2 different 3-year time periods; the first during active VRE surveillance and contact precautions and the second after discontinuation of these policies. We assessed the collateral impact of this policy change on the incidence of bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection even though we maintained contact precautions for these organisms. Incidence of infectious events was measured as number of events per 1,000 patients days per month. Time series analysis was used to evaluate trends. RESULTS The incidence of VRE bacteremia remained stable after discontinuation of VRE surveillance and contact precautions. The incidence of MRSA bacteremia and Clostridium difficile infection for which we continued contact precautions also remained stable. Aggregated antibiotic utilization and nursing hours per patient days were similar between the 2 study periods. CONCLUSION Active surveillance and contact precautions for VRE colonization did not appear to prevent VRE bacteremia in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation with high prevalence of VRE characterized by predominantly sporadic molecular epidemiology.

show abstract

“…A relatively small number of articles described VRE colonization in hematological patients 10,[16][17][18][19] . Immunosuppressed patients appear to be at special risk for VRE colonization and severe VRE infections.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for vancomycin-resistant Enterococcus colonization in hematologic patients

et al. 2013

View full text Add to dashboard Cite

show abstract

Molecular Epidemiology and Risk Factors for Colonization by Vancomycin-ResistantEnterococcusin Patients with Hematologic Malignancies

Cited by 22 publications

References 31 publications

Increase in Bloodstream Infection Due to Vancomycin-Susceptible Enterococcus faecium in Cancer Patients: Risk Factors, Molecular Epidemiology and Outcomes

Increase in Bloodstream Infection Due to Vancomycin-Susceptible Enterococcus faecium in Cancer Patients: Risk Factors, Molecular Epidemiology and Outcomes

Discontinuation of Systematic Surveillance and Contact Precautions for Vancomycin-ResistantEnterococcus(VRE) and Its Impact on the Incidence of VREfaeciumBacteremia in Patients with Hematologic Malignancies

Risk factors for vancomycin-resistant Enterococcus colonization in hematologic patients

Contact Info

Product

Resources

About