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

Sakka, Vissaria; Tsiodras, Sotirios; Galani, Lambrini; Antoniadou, Anastasia; Souli, María; Galani, I.; Pantelaki, M.; Siafakas, Nikolaos; Zerva, Loukia; Giamarellou, Helen

doi:10.1111/j.1469-0691.2007.01840.x

Cited by 79 publications

(61 citation statements)

References 46 publications

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“…The second type of control group, patients uninfected with the resistant organism of interest, avoids the problem of overestimating the association between antibiotic exposure and resistance. A study by Fernandez et al (98) is an example of the minority of case-control studies with this design (20,(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109). This study compared cases with ESBL-producing Enterobacter cloacae isolated in clinical cultures to controls who did not have ESBL-producing E. cloacae isolated.…”

Section: Case-control Studiesmentioning

confidence: 99%

Epidemiological Interpretation of Studies Examining the Effect of Antibiotic Usage on Resistance

et al. 2013

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SUMMARY Bacterial resistance to antibiotics is a growing clinical problem and public health threat. Antibiotic use is a known risk factor for the emergence of antibiotic resistance, but demonstrating the causal link between antibiotic use and resistance is challenging. This review describes different study designs for assessing the association between antibiotic use and resistance and discusses strengths and limitations of each. Approaches to measuring antibiotic use and antibiotic resistance are presented. Important methodological issues such as confounding, establishing temporality, and control group selection are examined.

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Section: Case-control Studiesmentioning

confidence: 99%

Epidemiological Interpretation of Studies Examining the Effect of Antibiotic Usage on Resistance

et al. 2013

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“…Worldwide, most of the studies about risk factors of mortality and enterococci were conducted using vancomycin-resistant strains [14]. In Argentina, research about severe enterococcal infection has been focused on antimicrobial-resistant strains [15].…”

Section: Introductionmentioning

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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“…Vancomycin-resistant enterococcus (VRE) colonization also is associated with an increased risk of infection in highrisk patient populations, including liver and allogeneic bone marrow transplant recipients (3,4). Infection with MRSA and VRE have been associated with an increased risk of morbidity, including organ dysfunction, excess length of hospital stay, biliary complications following liver transplant, increased health care costs and mortality (3)(4)(5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Colonization with MRSA and VRE Among Liver Transplant Candidates and Recipients

Russell¹,

Flood²,

Zaroda³

et al. 2008

American Journal of Transplantation

150

135

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Methicillin-resistant Staphylococcus aureus (MRSA)and vancomycin-resistant enterococcus (VRE) infections cause significant morbidity and mortality among liver transplant candidates and recipients. To assess rates of MRSA and VRE colonization, we obtained active surveillance cultures from 706 liver transplant candidates and recipients within 24 h of admission to an 11-bed liver transplant ICU from October 2000 to December 2005. Patients were followed prospectively to determine the cumulative risk of MRSA or VRE infection or death by colonization status. Outcomes were assessed by Kaplan-Meier survival analysis and Cox regression and multivariate logistic regression adjusting for covariates. The prevalence of newly detected MRSA nasal and VRE rectal colonization was 6.7% and 14.6%, respectively. Liver transplant candidates and recipients with MRSA colonization had an increased risk of MRSA infection (adjusted OR = 15.64, 95% CI 6.63-36.89) but not of death (adjusted OR = 1.00, 95% CI 0.43-2.30), whereas those with VRE colonization had an increased risk both of VRE infection (adjusted OR = 3.61, 95% CI 2.01-6.47) and of death (adjusted OR = 2.12, 95% CI 1.27-3.54) compared with noncolonized patients. Prevention and control strategies, including use of active surveillance cultures, should be implemented to reduce the rates of both MRSA and VRE colonization in this high-risk patient population.

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

Cited by 79 publications

References 46 publications

Epidemiological Interpretation of Studies Examining the Effect of Antibiotic Usage on Resistance

Epidemiological Interpretation of Studies Examining the Effect of Antibiotic Usage on Resistance

Clinical and microbiological features of bacteremia caused by Enterococcus faecalis

Outcomes of Colonization with MRSA and VRE Among Liver Transplant Candidates and Recipients

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