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Hassoun-Kheir N, Guedes M, Ngo Nsoga MT, Argante L, Arieti F, Gladstone BP, Kingston R, Naylor NR, Pezzani MD, Pouwels KB, Robotham JV, Rodríguez-Baño J, Tacconelli E, Vella V, Harbarth S, de Kraker MEA. A systematic review on the excess health risk of antibiotic-resistant bloodstream infections for six key pathogens in Europe. Clin Microbiol Infect 2024; 30 Suppl 1:S14-S25. [PMID: 37802750 DOI: 10.1016/j.cmi.2023.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Antimicrobial resistance is a global threat, which requires novel intervention strategies, for which priority pathogens and settings need to be determined. OBJECTIVES We evaluated pathogen-specific excess health burden of drug-resistant bloodstream infections (BSIs) in Europe. METHODS A systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, and grey literature for the period January 1990 to May 2022. STUDY ELIGIBILITY CRITERIA Studies that reported burden data for six key drug-resistant pathogens: carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, third-generation cephalosporin or CR Escherichia coli and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium. Excess health outcomes compared with drug-susceptible BSIs or uninfected patients. For MRSA and third-generation cephalosporin E. coli and K. pneumoniae BSIs, five or more European studies were identified. For all others, the search was extended to high-income countries. PARTICIPANTS Paediatric and adult patients diagnosed with drug-resistant BSI. INTERVENTIONS Not applicable. ASSESSMENT OF RISK OF BIAS An adapted version of the Joanna-Briggs Institute assessment tool. METHODS OF DATA SYNTHESIS Random-effect models were used to pool pathogen-specific burden estimates. RESULTS We screened 7154 titles, 1078 full-texts and found 56 studies on BSIs. Most studies compared outcomes of drug-resistant to drug-susceptible BSIs (46/56, 82.1%), and reported mortality (55/56 studies, 98.6%). The pooled crude estimate for excess all-cause mortality of drug-resistant versus drug-susceptible BSIs ranged from OR 1.31 (95% CI 1.03-1.68) for CR P. aeruginosa to OR 3.44 (95% CI 1.62-7.32) for CR K. pneumoniae. Pooled crude estimates comparing mortality to uninfected patients were available for vancomycin-resistant Enterococcus and MRSA BSIs (OR of 11.19 [95% CI 6.92-18.09] and OR 6.18 [95% CI 2.10-18.17], respectively). CONCLUSIONS Drug-resistant BSIs are associated with increased mortality, with the magnitude of the effect influenced by pathogen type and comparator. Future research should address crucial knowledge gaps in pathogen- and infection-specific burdens to guide development of novel interventions.
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Affiliation(s)
- Nasreen Hassoun-Kheir
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
| | - Mariana Guedes
- Department of Medicine, University of Sevilla/Instituto de Biomedicina de Sevilla (IBiS)/Consejo Superior de Investigaciones Científicas (CSIC), Sevilla, Spain; Infectious Diseases and Microbiology Division, Hospital Universitario Virgen Macarena, Sevilla, Spain; Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Marie-Therese Ngo Nsoga
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
| | - Lorenzo Argante
- Department of Vaccine Clinical Statistics, GSK, Siena, Italy
| | - Fabiana Arieti
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Beryl P Gladstone
- The German Center for Infection Research (DZIF)-Clinical Research Unit, Infectious Diseases, Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Rhys Kingston
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, United Kingdon Health Security Agency, London, UK
| | - Nichola R Naylor
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, United Kingdon Health Security Agency, London, UK
| | - Maria D Pezzani
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Koen B Pouwels
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julie V Robotham
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, United Kingdon Health Security Agency, London, UK
| | - Jesús Rodríguez-Baño
- Department of Medicine, University of Sevilla/Instituto de Biomedicina de Sevilla (IBiS)/Consejo Superior de Investigaciones Científicas (CSIC), Sevilla, Spain; Infectious Diseases and Microbiology Division, Hospital Universitario Virgen Macarena, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Venanzio Vella
- Department of Bacterial Vaccine Epidemiology, GSK, Siena, Italy
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
| | - Marlieke E A de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland.
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2
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Joshi S, Shallal A, Zervos M. Vancomycin-Resistant Enterococci: Epidemiology, Infection Prevention, and Control. Infect Dis Clin North Am 2021; 35:953-968. [PMID: 34752227 DOI: 10.1016/j.idc.2021.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vancomycin-resistant enterococcus (VRE) is a pathogen of growing concern due to increasing development of antibiotic resistance, increasing length of hospitalizations and excess mortality. The utility of some infection control practices are debatable, as newer developments in infection prevention strategies continued to be discovered. This article summarizes the significance of VRE and VRE transmission, along with highlighting key changes in infection control practices within the past 5 years.
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Affiliation(s)
- Seema Joshi
- Division of Infectious Diseases, Henry Ford Hospital, CFP-3, 2799 W Grand Boulevard, Detroit, MI, USA.
| | - Anita Shallal
- Division of Infectious Diseases, Henry Ford Hospital, CFP-3, 2799 W Grand Boulevard, Detroit, MI, USA
| | - Marcus Zervos
- Wayne State University, CFP-3, 2799 W Grand Boulevard, Detroit, MI, USA
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3
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Xie O, Slavin MA, Teh BW, Bajel A, Douglas AP, Worth LJ. Epidemiology, treatment and outcomes of bloodstream infection due to vancomycin-resistant enterococci in cancer patients in a vanB endemic setting. BMC Infect Dis 2020; 20:228. [PMID: 32188401 PMCID: PMC7079500 DOI: 10.1186/s12879-020-04952-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background Vancomycin-resistant enterococcus (VRE) is an important cause of infection in immunocompromised populations. Few studies have described the characteristics of vanB VRE infection. We sought to describe the epidemiology, treatment and outcomes of VRE bloodstream infections (BSI) in a vanB predominant setting in malignant hematology and oncology patients. Methods A retrospective review was performed at two large Australian centres and spanning a 6-year period (2008–2014). Evaluable outcomes were intensive care admission (ICU) within 48 h of BSI, all-cause mortality (7 and 30 days) and length of admission. Results Overall, 106 BSI episodes were observed in 96 patients, predominantly Enterococcus faecium vanB (105/106, 99%). Antibiotics were administered for a median of 17 days prior to BSI, and 76/96 (79%) were neutropenic at BSI onset. Of patients screened before BSI onset, 49/72 (68%) were found to be colonised. Treatment included teicoplanin (59), linezolid (6), daptomycin (2) and sequential/multiple agents (21). Mortality at 30-days was 31%. On multivariable analysis, teicoplanin was not associated with mortality at 30 days. Conclusions VRE BSI in a vanB endemic setting occurred in the context of substantive prior antibiotic use and was associated with high 30-day mortality. Targeted screening identified 68% to be colonised prior to BSI. Teicoplanin therapy was not associated with poorer outcomes and warrants further study for vanB VRE BSI in cancer populations.
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Affiliation(s)
- Ouli Xie
- Victorian Infectious Disease Service, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.
| | - Monica A Slavin
- Victorian Infectious Disease Service, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.,Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Infections in Cancer, Melbourne, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Infections in Cancer, Melbourne, Australia
| | - Ashish Bajel
- Department of Haematology, The Royal Melbourne Hospital, Parkville, Australia.,Department of Haematology, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Abby P Douglas
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Infections in Cancer, Melbourne, Australia
| | - Leon J Worth
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Infections in Cancer, Melbourne, Australia
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4
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Dubler S, Lenz M, Zimmermann S, Richter DC, Weiss KH, Mehrabi A, Mieth M, Bruckner T, Weigand MA, Brenner T, Heininger A. Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study. Antimicrob Resist Infect Control 2020; 9:22. [PMID: 32005223 PMCID: PMC6995054 DOI: 10.1186/s13756-020-0683-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The relevance of vancomycin resistance in enterococcal blood stream infections (BSI) is still controversial. Aim of this study was to outline the effect of vancomycin resistance of Enterococcus faecium on the outcome of patients with BSI after orthotopic liver transplantation (OLT). METHODS The outcome of OLT recipients developing BSI with vancomycin-resistant (VRE) versus vancomycin-susceptible Enterococcus faecium (VSE) was compared based on data extraction from medical records. Multivariate regression analyses identified risk factors for mortality and unfavourable outcomes (defined as death or prolonged intensive care stay) after 30 and 90 days. RESULTS Mortality was similar between VRE- (n = 39) and VSE- (n = 138) group after 30 (p = 0.44) or 90 days (p = 0.39). Comparable results occurred regarding unfavourable outcomes. Mean SOFANon-GCS score during the 7-day-period before BSI onset was the independent predictor for mortality at both timepoints (HR 1.32; CI 1.14-1.53; and HR 1.18; CI 1.08-1.28). Timely appropriate antibiotic therapy, recent ICU stay and vancomycin resistance did not affect outcome after adjusting for confounders. CONCLUSION Vancomycin resistance did not influence outcome among patients with Enterococcus faecium bacteraemia after OLT. Only underlying severity of disease predicted poor outcome among this homogenous patient population. TRIAL REGISTRATION This study was registered at the German clinical trials register (DRKS-ID: DRKS00013285).
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Affiliation(s)
- S Dubler
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
| | - M Lenz
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.,Department of Anaesthesiology, Intensive Care and Emergency Medicine, Asklepios Clinics Hamburg, AK Wandsbek, Hamburg, Germany
| | - S Zimmermann
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Division Bacteriology, Heidelberg University Hospital, Heidelberg, Germany
| | - D C Richter
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - K H Weiss
- Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - A Mehrabi
- Department of Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Mieth
- Department of Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - M A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - T Brenner
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - A Heininger
- Division Hospital and Environmental Hygiene Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
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Gouliouris T, Warne B, Cartwright EJP, Bedford L, Weerasuriya CK, Raven KE, Brown NM, Török ME, Limmathurotsakul D, Peacock SJ. Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: a nested case-control study. J Antimicrob Chemother 2019; 73:1692-1699. [PMID: 29548009 PMCID: PMC5961253 DOI: 10.1093/jac/dky075] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/12/2018] [Indexed: 01/02/2023] Open
Abstract
Background VRE bacteraemia has a high mortality and continues to defy control. Antibiotic risk factors for VRE bacteraemia have not been adequately defined. We aimed to determine the risk factors for VRE bacteraemia focusing on duration of antibiotic exposure. Methods A retrospective matched nested case-control study was conducted amongst hospitalized patients at Cambridge University Hospitals NHS Foundation Trust (CUH) from 1 January 2006 to 31 December 2012. Cases who developed a first episode of VRE bacteraemia were matched 1:1 to controls by length of stay, year, specialty and ward type. Independent risk factors for VRE bacteraemia were evaluated using conditional logistic regression. Results Two hundred and thirty-five cases were compared with 220 controls. Duration of exposure to parenteral vancomycin, fluoroquinolones and meropenem was independently associated with VRE bacteraemia. Compared with patients with no exposure to vancomycin, those who received courses of 1–3 days, 4–7 days or >7 days had a stepwise increase in risk of VRE bacteraemia [conditional OR (cOR) 1.2 (95% CI 0.4–3.8), 3.8 (95% CI 1.2–11.7) and 6.6 (95% CI 1.9–22.8), respectively]. Other risk factors were: presence of a central venous catheter (CVC) [cOR 8.7 (95% CI 2.6–29.5)]; neutropenia [cOR 15.5 (95% CI 4.2–57.0)]; hypoalbuminaemia [cOR 8.5 (95% CI 2.4–29.5)]; malignancy [cOR 4.4 (95% CI 1.6–12.0)]; gastrointestinal disease [cOR 12.4 (95% CI 4.2–36.8)]; and hepatobiliary disease [cOR 7.9 (95% CI 2.1–29.9)]. Conclusions Longer exposure to vancomycin, fluoroquinolones or meropenem was associated with VRE bacteraemia. Antimicrobial stewardship interventions targeting high-risk antibiotics are required to complement infection control procedures against VRE bacteraemia.
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Affiliation(s)
- Theodore Gouliouris
- Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ben Warne
- Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Luke Bedford
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
| | | | - Kathy E Raven
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Nick M Brown
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
| | - M Estée Török
- Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
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6
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Hughes A, Ballard S, Sullivan S, Marshall C. An outbreak of vanA vancomycin-resistant Enterococcus faecium in a hospital with endemic vanB VRE. Infect Dis Health 2019; 24:82-91. [PMID: 30638872 DOI: 10.1016/j.idh.2018.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In Australia, vanB vancomycin-resistant Enterococcus faecium (VREfm) has been endemic for over 20 years, but vanA VREfm isolates have rarely been reported. METHODS This outbreak report describes an outbreak of vanA VREfm in the intensive care unit (ICU) and cardiothoracic surgery (CTS) wards of a Melbourne hospital in 2015-2016. After the cluster was initially identified in the ICU ward, an active screening programme was implemented. VRE isolates were typed using in silico multi-locus sequence typing. In addition, to screening, enhanced environmental cleaning, chlorhexidine gluconate body washes, and standardisation of the surgical antibiotic prophylaxis regimen were implemented to control the outbreak. RESULTS There were 83 new isolates of vanA VREfm recovered from patients in the ICU (n = 31) and CTS (n = 52) wards. Screening identified 78 (94%) of cases. Three patients required treatment for clinical infection with vanA VREfm during the outbreak. The outbreak was polyclonal with 5 different multilocus sequence types carrying the vanA gene (ST17, ST80, ST203, ST252 and ST1421) detected from a subset of isolates (N = 43). The ST17 isolates all carried both the vanA and vanB gene. The intervention bundle resulted in control of the outbreak after 10 months. CONCLUSION Geographically, vanA VREfm has previously been uncommon in the region and this outbreak represents a change in local epidemiology. Few VRE outbreaks have been reported in CTS patients. The infection control responses controlled the outbreak within 10-months and may help guide future management of outbreaks.
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Affiliation(s)
- Angus Hughes
- University of Melbourne, School of Biomedical Sciences, Parkville, VIC 3010, Australia
| | - Susan Ballard
- Microbiological Diagnostic Unit Public Health Laboratory (MDU PHL), Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia
| | - Sheena Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia; School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia
| | - Caroline Marshall
- University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC 3010, Australia; Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; NHMRC National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000, Australia.
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7
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Johnstone J, Chen C, Rosella L, Adomako K, Policarpio ME, Lam F, Prematunge C, Garber G, Evans GA, Gardam M, Hota S, John M, Katz K, Lemieux C, McGeer A, Mertz D, Muller MP, Roth V, Suh KN, Vearncombe M. Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada. Am J Infect Control 2018; 46:1266-1271. [PMID: 29903421 DOI: 10.1016/j.ajic.2018.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia. METHODS All patients with a confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013 were linked to provincial healthcare administrative data sources and frequency matched to 3 controls based on age, sex, and aggregated diagnosis group. Associations between predictors and VRE bacteremia were estimated by generalized estimating equations and summarized using odds ratios (ORs) and corresponding 95% confidence intervals (CIs). RESULTS In total, 217 cases and 651 controls were examined. In adjusted analyses, patient-level predictors included bone marrow transplant (OR 106.99 [95% CI 12.19-939.26]); solid organ transplant (OR 17.17 [95% CI 4.95-59.54]); any cancer (OR 8.64 [95% CI 3.88-19.21]); intensive care unit (ICU) admission (OR 6.81 [95% CI 3.53-13.13]); heart disease (OR 5.27 [95% CI 2.00-13.90]); and longer length of stay (OR 1.07 per day [95% CI 1.06-1.09]). Hospital-level predictors included hospital size (per increase in 100 beds (OR 1.26 [95% CI 1.07-1.48]) and teaching hospitals (OR 3.87 [95% CI 1.85-8.08]). CONCLUSIONS Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the ICU are at highest risk of VRE bacteremia, particularly at large hospitals and teaching hospitals.
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8
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Coppry M, Jeanne-Leroyer C, Noize P, Dumartin C, Boyer A, Bertrand X, Dubois V, Rogues AM. Antibiotics associated with acquisition of carbapenem-resistantPseudomonas aeruginosain ICUs: a multicentre nested case–case–control study. J Antimicrob Chemother 2018; 74:503-510. [DOI: 10.1093/jac/dky427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/19/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Coppry
- Univ. Bordeaux, CHU Bordeaux, Hygiène hospitalière, F-33000 Bordeaux, France
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000 Bordeaux, France
| | | | - P Noize
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000 Bordeaux, France
| | - C Dumartin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000 Bordeaux, France
- Univ. Bordeaux, CHU Bordeaux, CPIAS Nouvelle-Aquitaine, F-33000 Bordeaux, France
| | - A Boyer
- Univ. Bordeaux, CHU Bordeaux, Réanimation médicale, F-33000 Bordeaux, France
| | - X Bertrand
- Univ. Besançon, CHU Besançon, Hygiène hospitalière, F-25000 Besançon, France
| | - V Dubois
- Univ. Bordeaux, CHU Bordeaux, Laboratoire de bactériologie, F-33000 Bordeaux, France
- Univ. Bordeaux, CNRS UMR 5234, F33000 Bordeaux, France
| | - A -M Rogues
- Univ. Bordeaux, CHU Bordeaux, Hygiène hospitalière, F-33000 Bordeaux, France
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team PHARMACOEPIDEMIOLOGY, UMR 1219, F-33000 Bordeaux, France
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9
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Messina JA, Sinha R, Starr K, Arshad M, Alexander BD, Chao NJ, Sung AD. Clinical and Genomic Characterization of Recurrent Enterococcal Bloodstream Infection in Patients With Acute Leukemia. Open Forum Infect Dis 2018; 5:ofy107. [PMID: 29977964 PMCID: PMC6016419 DOI: 10.1093/ofid/ofy107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background Rates and risk factors for recurrent enterococcal bloodstream infection (R-EBSI) and whether the same genetic lineage causes index EBSI and R-EBSI are unknown in patients with acute leukemia (AL) receiving chemotherapy. Methods Ninety-two AL patients with EBSI from 2010 to 2015 were included. Enterococcal bloodstream infection was defined by 31 positive blood cultures for Enterococcus faecium or Enterococcus faecalis and fever, hypotension, or chills. Clearance was defined by 31 negative cultures 324 hours after last positive culture and defervescence. Recurrent enterococcal bloodstream infection was defined by a positive blood culture for Enterococcus 324 hours after clearance. Categorical variables were reported as proportions and compared by the χ2 test. Continuous variables were summarized by median and interquartile range (IQR) and compared by the Wilcoxon-Mann-Whitney Test. P values <.05 were considered significant. Whole-genome sequencing was performed on available paired BSI isolates from 7 patients. Results Twenty-four patients (26%) had 31 episodes of R-EBSI. Median time to R-EBSI (IQR) was 26 (13–50) days. Patients with R-EBSI had significantly longer durations of fever and metronidazole exposure during their index EBSI. Thirty-nine percent of E. faecium R-EBSI isolates became daptomycin-nonsusceptible Enterococcus (DNSE) following daptomycin therapy for index EBSI. Whole-genome sequencing analysis confirmed high probability of genetic relatedness of index EBSI and R-EBSI isolates for 4/7 patients. Conclusions Recurrent enterococcal bloodstream infection and DNSE are common in patients with AL and tend to occur within the first 30 days of index EBSI. Duration of fever and metronidazole exposure may be useful in determining risk for R-EBSI. Whole-genome sequencing analysis demonstrates that the same strain causes both EBSI and R-EBSI in some patients.
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Affiliation(s)
- Julia A Messina
- Division of Infectious Diseases, Department of Medicine, Durham, North Carolina
| | - Rohita Sinha
- Division of Hematologic Malignancies and Cellular Therapies, Department of Medicine, Duke University, Durham, North Carolina
| | - Kimberly Starr
- Department of Food Science and Technology, University of Nebraska-Lincoln, Nebraska, Nebraska
| | - Mehreen Arshad
- Clinical Microbiology Laboratory, Department of Pathology, Durham, North Carolina
| | - Barbara D Alexander
- Division of Infectious Diseases, Department of Medicine, Durham, North Carolina
| | - Nelson J Chao
- Division of Infectious Diseases, Department of Pediatrics, Durham, North Carolina
| | - Anthony D Sung
- Division of Infectious Diseases, Department of Pediatrics, Durham, North Carolina
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10
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Factors contributing to vancomycin-resistant Enterococcus spp. horizontal transmission events: exploration of the role of antibacterial consumption. Diagn Microbiol Infect Dis 2017; 89:72-77. [DOI: 10.1016/j.diagmicrobio.2017.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/27/2017] [Indexed: 12/18/2022]
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11
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Flokas ME, Karageorgos SA, Detsis M, Alevizakos M, Mylonakis E. Vancomycin-resistant enterococci colonisation, risk factors and risk for infection among hospitalised paediatric patients: a systematic review and meta-analysis. Int J Antimicrob Agents 2017; 49:565-572. [PMID: 28336313 DOI: 10.1016/j.ijantimicag.2017.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/20/2016] [Accepted: 01/06/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study was to estimate the rate and significance of colonisation with vancomycin-resistant enterococci (VRE) among hospitalised children. The PubMed and EMBASE databases were systematically searched (last accessed on 29 May 2016) to identify studies evaluating VRE colonisation of the gastrointestinal tract of hospitalised children in non-outbreak periods. Of 945 non-duplicate citations, 19 studies enrolling 20 234 children were included. The overall and paediatric intensive care unit (PICU) rate of VRE colonisation were both 5% [95% confidence interval (CI) 3-8% overall and 95% CI 2-9% in the PICU] but was 23% in haematology/oncology units (95% CI 18-29%). Studies that were exclusively performed in haematology/oncology units reported significantly higher rates compared with all other studies in the univariate and multivariate analyses (P = 0.001). Previous vancomycin [risk ratio (RR) = 4.34, 95% CI 2.77-6.82] or ceftazidime (RR = 4.15, 95% CI 2.69-6.40) use was a risk factor for VRE colonisation. Importantly, VRE colonisation increased the risk of subsequent VRE infection (RR = 8.75, 95% CI 3.19-23.97). In conclusion, a high rate of VRE colonisation was found among hospitalised children in institutions that performed targeted screening. Importantly, colonised children were almost 9 times more likely to develop subsequent VRE infection. Judicious use of specific antibiotics along with intensification of infection control measures should be considered in high-prevalence institutions. Also, the high incidence of VRE colonisation among children with haematological/oncological diseases identifies a high-risk population.
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Affiliation(s)
- Myrto Eleni Flokas
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Spyridon A Karageorgos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Marios Detsis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Michail Alevizakos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA.
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Meng X, Liu S, Duan J, Huang X, Zhou P, Xiong X, Gong R, Zhang Y, Liu Y, Fu C, Li C, Wu A. Risk factors and medical costs for healthcare-associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital. BMC Infect Dis 2017; 17:82. [PMID: 28095785 PMCID: PMC5242049 DOI: 10.1186/s12879-016-2176-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/27/2016] [Indexed: 01/03/2023] Open
Abstract
Background The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital. Methods We conducted a retrospective, matched case–control–control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection. Results Multivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26–12.42), tracheostomy (OR:2.24; 95%CI: 1.14–4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31–28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52–95.4), urinary system disease (OR: 16.69; 95%CI: 3.01–89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46–5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89–26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01). Conclusion Many factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality.
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Affiliation(s)
- Xiujuan Meng
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Sidi Liu
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Juping Duan
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Xun Huang
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Pengcheng Zhou
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Xinrui Xiong
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Ruie Gong
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Ying Zhang
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Yao Liu
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Chenchao Fu
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Chunhui Li
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
| | - Anhua Wu
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
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Longitudinal Multicenter Analysis of Outcomes After Cessation of Control Measures for Vancomycin-Resistant Enterococci. Infect Control Hosp Epidemiol 2016; 38:24-30. [DOI: 10.1017/ice.2016.235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVETo assess clinically relevant outcomes after complete cessation of control measures for vancomycin-resistant enterococci (VRE).DESIGNQuasi-experimental ecological study over 3.5 years.METHODSAll VRE screening and isolation practices at 4 large academic hospitals in Ontario, Canada, were stopped on July 1, 2012. In total, 618 anonymized abstracted charts of patients with VRE-positive clinical isolates identified between July 1, 2010, and December 31, 2013, were reviewed to determine whether the case was a true VRE infection, a VRE colonization or contaminant, or a true VRE bacteremia. All deaths within 30 days of the last VRE infection were also reviewed to determine whether the death was fully or partially attributable to VRE. All-cause mortality was evaluated over the study period. Generalized estimating equation methods were used to cluster outcome rates within hospitals, and negative binomial models were created for each outcome.RESULTSThe incidence rate ratio (IRR) for VRE infections was 0.59 and the associatedPvalue was .34. For VRE bacteremias, the IRR was 0.54 andP=.38; for all-cause mortality the IRR was 0.70 andP=.66; and for VRE attributable death, the IRR was 0.35 andP=.49. VRE control measures were not significantly associated with any of the outcomes. Rates of all outcomes appeared to increase during the 18-month period after cessation of VRE control measures, but none reached statistical significance.CONCLUSIONClinically significant VRE outcomes remain rare. Cessation of all control measures for VRE had no significant attributable adverse clinical impact.Infect Control Hosp Epidemiol2016;1–7
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VRE and VSE Bacteremia Outcomes in the Era of Effective VRE Therapy: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol 2015; 37:26-35. [PMID: 26434609 PMCID: PMC4707508 DOI: 10.1017/ice.2015.228] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prior data suggest that vancomycin-resistant Enterococcus (VRE)
bacteremia is associated with worse outcomes than vancomycin-sensitive
Enterococcus (VSE) bacteremia. However, many studies evaluating such
outcomes were conducted prior to the availability of effective VRE therapies. OBJECTIVE To systematically review VRE and VSE bacteremia outcomes among hospital patients in the
era of effective VRE therapy. METHODS Electronic databases and grey literature published between January 1997 and December
2014 were searched to identify all primary research studies comparing outcomes of VRE
and VSE bacteremias among hospital patients, following the availability of effective VRE
therapies. The primary outcome was all-cause, in-hospital mortality, while total
hospital length of stay (LOS) was a secondary outcome. All meta-analyses were conducted
in Review Manager 5.3 using random-effects, inverse variance modeling. RESULTS Among all the studies reviewed, 12 cohort studies and 1 case control study met
inclusion criteria. Similar study designs were combined in meta-analyses for mortality
and LOS. VRE bacteremia was associated with increased mortality compared with VSE
bacteremia among cohort studies (odds ratio [OR], 1.80; 95% confidence interval [CI],
1.38–2.35; I2=0%; n=11); the case-control study estimate was similar, but not
significant (OR, 1.93; 95% CI, 0.97–3.82). LOS was greater for VRE bacteremia patients
than for VSE bacteremia patients (mean difference, 5.01 days; 95% CI, 0.58–9.44];
I2=0%; n=5). CONCLUSIONS Despite the availability of effective VRE therapy, VRE bacteremia remains associated
with an increased risk of in-hospital mortality and LOS when compared to VSE bacteremia. Infect. Control Hosp. Epidemiol. 2015;37(1):26–35
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Delago A, Mandabi A, Meijler MM. Natural Quorum Sensing Inhibitors - Small Molecules, Big Messages. Isr J Chem 2015. [DOI: 10.1002/ijch.201500052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Wilcox MH. Editorial Commentary: Critically Ill Patients With Clostridium difficile Infection: Are 2 Antibiotics Better Than One? Clin Infect Dis 2015; 61:942-4. [PMID: 26024908 DOI: 10.1093/cid/civ413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 12/29/2022] Open
Affiliation(s)
- Mark H Wilcox
- Leeds Teaching Hospitals NHS Trust University of Leeds, United Kingdom
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