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Marosi B, Kádár B, Bruzsa A, Kocsis L, Kamotsay K, Sinkó J, Szabó BG, Lakatos B. Characteristics of Enterococcus species bloodstream infections among adults with and without onco-hematological malignancies: Experiences from the national center of Hungary. Eur J Microbiol Immunol (Bp) 2024; 14:134-142. [PMID: 38536399 PMCID: PMC11097792 DOI: 10.1556/1886.2024.00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/17/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Over the past decade, enterococcal bloodstream infection (BSI) shows increasing incidence globally among the elderly and in patients with comorbidities. In this study, we aimed to assess microbiological and clinical characteristics and long-term outcomes of BSIs caused by Enterococcus spp. in adult patients with and without active onco-hematological malignancies hospitalized at a national referral institute. Methods A prospective analysis of consecutive enterococcal BSI cases was conducted in the National Institute of Hematology and Infectious Diseases (Budapest, Hungary) between December 2019 and April 2022. We compared characteristics and outcomes at 30-days and 1 year after diagnosis among patients with and without onco-hematological malignancies. Results In total, 141 patients were included (median age 68 ± 21 years, female sex 36.9%), 37% (52/141) had active onco-hematological malignancies. The distribution of species was as follows: 50.4% Enterococcus faecalis, 46.1% Enterococcus faecium, 1.4% Enterococcus avium and Enterococcus gallinarum, and 0.7% Enterococcus raffinosus. No statistically significant differences in all-cause mortality rates were observed between patient subgroups at 30 days (32.7 vs. 28.1%; P = 0.57) and 1 year (75.0 vs. 60.7%; P = 0.09). Conclusion Enterococcal bloodstream infections yielded a relevant burden of morbidity, but with no statistical difference in long-term outcomes of adult patients with and without active onco-hematological malignancies.
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Affiliation(s)
- Bence Marosi
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., H-1085, Budapest, Hungary
| | - Béla Kádár
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Anna Bruzsa
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Laura Kocsis
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Katalin Kamotsay
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - János Sinkó
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Bálint Gergely Szabó
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., H-1085, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
| | - Botond Lakatos
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Üllői Street 26., H-1085, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Albert Flórián Street 5-7., H-1097, Budapest, Hungary
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Hansen SGK, Klein K, Nymark A, Andersen L, Gradel KO, Lis-Toender J, Oestergaard C, Chen M, Datcu R, Skov MN, Holm A, Rosenvinge FS. Vancomycin-resistant Enterococcus faecium: impact of ending screening and isolation in a Danish University hospital. J Hosp Infect 2024; 146:82-92. [PMID: 38360093 DOI: 10.1016/j.jhin.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/11/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Substantial resources are used in hospitals worldwide to counteract the ever-increasing incidence of vancomycin-resistant and vancomycin-variable Enterococcus faecium (VREfm and VVEfm), but it is important to balance patient safety, infection prevention, and hospital costs. AIM To investigate the impact of ending VREfm/VVEfm screening and isolation at Odense University Hospital (OUH), Denmark, on patient and clinical characteristics, risk of bacteraemia, and mortality of VREfm/VVEfm disease at OUH. The burden of VREfm/VVEfm bacteraemia at OUH and the three collaborative hospitals in the Region of Southern Denmark (RSD) was also investigated. METHODS A retrospective cohort study was conducted including first-time VREfm/VVEfm clinical isolates (index isolates) detected at OUH and collaborative hospitals in the period 2015-2022. The intervention period with screening and isolation was from 2015 to 2021, and the post-intervention period was 2022. Information about clinical isolates was retrieved from microbiological databases. Patient data were obtained from hospital records. FINDINGS At OUH, 436 patients were included in the study, with 285 in the intervention period and 151 in the post-intervention period. Ending screening and isolation was followed by an increased number of index isolates. Besides a change in van genes, only minor non-significant changes were detected in all the other investigated parameters. Mortality within 30 days did not reflect the VREfm/VVEfm-attributable deaths, and in only four cases was VREfm/VVEfm infection the likely cause of death. CONCLUSION Despite an increasing number of index isolates, nothing in the short follow-up period supported a reintroduction of screening and isolation.
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Affiliation(s)
- S G K Hansen
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - K Klein
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A Nymark
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Andersen
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark
| | - K O Gradel
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Lis-Toender
- Department of Clinical Microbiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - C Oestergaard
- Department of Clinical Microbiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - M Chen
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - R Datcu
- Department of Clinical Microbiology, Esbjerg and Grindsted Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - M N Skov
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A Holm
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - F S Rosenvinge
- Department of Clinical Microbiology and Infection Control, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Thomsen J, Abdulrazzak NM, AlRand H, Menezes GA, Moubareck CA, Everett DB, Senok A, Podbielski A. Epidemiology of vancomycin-resistant enterococci in the United Arab Emirates: a retrospective analysis of 12 years of national AMR surveillance data. Front Public Health 2023; 11:1275778. [PMID: 38089023 PMCID: PMC10715431 DOI: 10.3389/fpubh.2023.1275778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Enterococci are usually low pathogenic, but can cause invasive disease under certain circumstances, including urinary tract infections, bacteremia, endocarditis, and meningitis, and are associated with peritonitis and intra-abdominal abscesses. Increasing resistance of enterococci to glycopeptides and fluoroquinolones, and high-level resistance to aminoglycosides is a concern. National antimicrobial resistance (AMR) surveillance data for enterococci from the Middle East and North Africa (MENA) and the Gulf region is scarce. Methods A retrospective 12-year analysis of N = 37,909 non-duplicate diagnostic Enterococcus spp. isolates from the United Arab Emirates (UAE) was conducted. Data was generated by routine patient care during 2010-2021, collected by trained personnel and reported by participating surveillance sites to the UAE National AMR Surveillance program. Data analysis was conducted with WHONET. Results Enterococcus faecalis was the most commonly reported species (81.5%), followed by Enterococcus faecium (8.5%), and other enterococci species (4.8%). Phenotypically vancomycin-resistant enterococci (VRE) were found in 1.8% of Enterococcus spp. isolates. Prevalence of VRE (%VRE) was highest for E. faecium (8.1%), followed by E. faecalis (0.9%). A significant level of resistance to glycopeptides (%VRE) for these two species has been observed in the majority of observed years [E. faecalis (0-2.2%), 2010: 0%, 2021: 0.6%] and E. faecium (0-14.2%, 2010: 0%, 2021: 5.8%). Resistance to fluoroquinolones was between 17 and 29% (E. faecalis) and was higher for E. faecium (between 42 and 83%). VRE were associated with higher patient mortality (RR: 2.97), admission to intensive care units (RR: 2.25), and increased length of stay (six excess inpatient days per VRE case), as compared to vancomycin-susceptible Enterococcus spp. Discussion Published data on Enterococcus infections, in particular VRE-infections, in the UAE and MENA region is scarce. Our data demonstrates that VRE-enterococci are relatively rare in the UAE, however showing an increasing resistance trend for several clinically important antibiotic classes, causing a concern for the treatment of serious infections caused by enterococci. This study also demonstrates that VRE were associated with higher mortality, increased intensive care unit admission rates, and longer hospitalization, thus poorer clinical outcome and higher associated costs in the UAE. We recommend the expansion of current surveillance techniques (e.g., local VRE screening), stricter infection prevention and control strategies, and better stewardship interventions. Further studies on the molecular epidemiology of enterococci are needed.
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Affiliation(s)
- Jens Thomsen
- Department of Environmental and Occupational Health and Safety, Abu Dhabi Public Health Center, Abu Dhabi, United Arab Emirates
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Najiba M. Abdulrazzak
- Al Kuwait Hospital Dubai, Emirates Health Services Establishment (EHS), Dubai, United Arab Emirates
| | - Hussain AlRand
- Public Health Sector, Ministry of Health and Prevention, Dubai, United Arab Emirates
| | | | - Godfred Antony Menezes
- Department of Medical Microbiology and Immunology, Ras Al Khaimah (RAK) Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Carole A. Moubareck
- College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Dean B. Everett
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
- Research Center, Khalifa University, Abu Dhabi, United Arab Emirates
- Infection Research Unit, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- School of Dentistry, Cardiff University, Cardiff, United Kingdom
| | - Andreas Podbielski
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine, Rostock, Germany
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Johar AA, Salih MA, Abdelrahman HA, Al Mana H, Hadi HA, Eltai NO. Wastewater-based epidemiology for tracking bacterial diversity and antibiotic resistance in COVID-19 isolation hospitals in Qatar. J Hosp Infect 2023; 141:209-220. [PMID: 37634602 DOI: 10.1016/j.jhin.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Hospitals are hotspots for antimicrobial resistance genes (ARGs), and play a significant role in their emergence and spread. Large numbers of ARGs will be ejected from hospitals via wastewater systems. Wastewater-based epidemiology has been consolidated as a tool to provide real-time information, and represents a promising approach to understanding the prevalence of bacteria and ARGs at community level. AIMS To determine bacterial diversity and identify ARG profiles in hospital wastewater pathogens obtained from coronavirus disease 2019 (COVID-19) isolation hospitals compared with non-COVID-19 facilities during the pandemic. METHODS Wastewater samples were obtained from four hospitals: three assigned to patients with COVID-19 patients and one assigned to non-COVID-19 patients. A microbial DNA quantitative polymerase chain reaction was used to determine bacterial diversity and ARGs. FINDINGS The assay recorded 27 different bacterial species in the samples, belonging to the following phyla: Firmicutes (44.4%), Proteobacteria (33.3%), Actinobacteria (11%), Bacteroidetes (7.4%) and Verrucomicrobiota (3.7%). In addition, 61 ARGs were detected in total. The highest number of ARGs was observed for the Hazem Mebaireek General Hospital (HMGH) COVID-19 patient site (88.5%), and the lowest number of ARGs was found for the HMGH non-patient site (24.1%). CONCLUSION The emergence of contaminants in sewage water, such as ARGs and high pathogen levels, poses a potential risk to public health and the aquatic ecosystem.
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Affiliation(s)
- A A Johar
- Research and Development Department, Barzan Holdings, Doha, Qatar
| | - M A Salih
- Biomedical Research Centre, Qatar University, Doha, Qatar
| | | | - H Al Mana
- Biomedical Research Centre, Qatar University, Doha, Qatar
| | - H A Hadi
- Communicable Diseases Centre, Infectious Disease Division, Hamad Medical Corporation, Doha, Qatar
| | - N O Eltai
- Biomedical Research Centre, Qatar University, Doha, Qatar.
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