Outcomes for and Risk Factors Associated With Vancomycin-ResistantEnterococcus faecalisand Vancomycin-ResistantEnterococcus faeciumBacteremia in Cancer Patients
- 1 September 2007
- journal article
- research article
- Published by Cambridge University Press (CUP) in Infection Control & Hospital Epidemiology
- Vol. 28 (9), 1054-1059
- https://doi.org/10.1086/519932
Abstract
Objective. Vancomycin-resistant enterococci (VRE) are a major cause of nosocomial infection. We sought to compare vancomycin-resistant (VR) Enterococcus faecalis bacteremia and VR Enterococcus faecium bacteremia in cancer patients with respect to risk factors, clinical presentation, microbiological characteristics, antimicrobial therapy, and outcomes. Methods. We identified 210 cancer patients with VRE bacteremia who had been treated between January 1996 and December 2004; 16 of these 210 had VR E. faecalis bacteremia and were matched with 32 patients with VR E. faecium bacteremia and 32 control patients. A retrospective review of medical records was conducted. Results. Logistic regression analysis showed that, compared with VR E. faecalis bacteremia, VR E. faecium bacteremia was associated with a worse clinical response to therapy (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.07-0.98]; P = .046) and a higher overall mortality rate (OR, 8.3 [95% CI, 1.9-35.3]; P = .004), but the VRE-related mortality rate did not show a statistically significant difference (OR, 6.8 [95% CI, 0.7-61.8]; P = .09). Compared with control patients, patients with VR E. faecalis bacteremia were more likely to have received an aminoglycoside in the 30 days before the onset of bacteremia (OR, 5.8 [95% CI, 1.2-27.6]; P = .03), whereas patients with VR E. faecium bacteremia were more likely to have received a carbapenem in the 30 days before the onset of bacteremia (OR, 11.7 [95% CI, 3.6-38.6]; P<.001). In a multivariate model that compared patients with VR E. faecium bacteremia and control patients, predictors of mortality included acute renal failure on presentation (OR, 15.1 [95% CI, 2.3-99.2]; P = .004) and VR E. faecium bacteremia (OR, 11 [95% CI, 2.7-45.1]; P<.001). No difference in outcomes was found between patients with VR E. faecalis bacteremia and control patients. Conclusions. VR E. faecium bacteremia in cancer patients was associated with a poorer outcome than was VR E. faecalis bacteremia. Recent receipt of carbapenem therapy was an independent risk factor for VR E. faecium bacteremia, and recent receipt of aminoglycoside therapy was independent risk factor for E. faecalis bacteremia.Keywords
This publication has 28 references indexed in Scilit:
- Risk factors for vancomycin-resistant Enterococcus faecalis bacteremia in hospitalized patients: An analysis of two case-control studiesAmerican Journal of Infection Control, 2006
- Reduction in Acquisition of Vancomycin-Resistant Enterococcus after Enforcement of Routine Environmental Cleaning MeasuresClinical Infectious Diseases, 2006
- Pathogenic enterococci: new developments in the 21st centuryCellular and Molecular Life Sciences, 2003
- Association Between Antecedent Intravenous Antimicrobial Exposure and Isolation of Vancomycin-Resistant EnterococciMicrobial Drug Resistance, 2003
- Role of Environmental Contamination as a Risk Factor for Acquisition of Vancomycin-Resistant Enterococci in Patients Treated in a Medical Intensive Care UnitArchives of Internal Medicine, 2003
- Modulation of virulence within a pathogenicity island in vancomycin-resistant Enterococcus faecalisNature, 2002
- National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from January 1992-June 2001, Issued August 2001American Journal of Infection Control, 2001
- Vancomycin-Resistant Enterococcal Bacteremia: Natural History and Attributable MortalityClinical Infectious Diseases, 1996
- In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalisAntimicrobial Agents and Chemotherapy, 1989
- Plasmid-Mediated Resistance to Vancomycin and Teicoplanin in Enterococcus FaeciumNew England Journal of Medicine, 1988