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Risk factors for development of vancomycin-resistant enterococcal bacteremia among VRE colonizers

A retrospective case control study

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Summary

Aims

We aimed to determine the proportion of vancomycin-resistant enterococci (VRE) colonized patients among all inpatients who later developed VRE bacteremia during hospital stay and to identify the risk factors for VRE bacteremia at a tertiary hospital.

Material and methods

Patients with positive rectal screening or any clinically significant positive culture results for VRE were included in 1‑year follow-up. Colonization with VRE was defined as a positive culture (rectal, stool, urinary) for VRE without infection and VRE bacteremia was defined as positive blood culture if the signs and symptoms were compatible with infection. To determine the risk factors for VRE bacteremia among VRE colonized patients, a retrospective case control study was performed. The two groups were compared in terms of variables previously defined as risk factors in the literature.

Results

Of 947 positive samples, 17 VRE bacteremia were included in the analysis. Cephalosporin use for more than 3 days within 3 months was a significant risk factor for bacteremia (p = 0.008). Prior use of carbapenems was found to be statistically significant for bacteremia (p = 0.007). In multivariate analyses the use of carbapenems and cephalosporins was an independent risk factor for developing bacteremia among VRE colonizers (odds ratio, OR, 6.67; 95% confidence interval, CI, 1.30–34; p = 0.022 and OR 4.32, 95% CI 1.23–15; p = 0.022, respectively).

Conclusion

A VRE colonization in patients receiving broad-spectrum beta-lactam antibiotics including carbapenems and cephalosporins may result in bacteremia. It is possible to keep mortality at very low levels in VRE bacteremia with effective infection control measures, rapid infectious diseases consultation and rational antimicrobial treatment based on current epidemiological data.

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References

  1. Hidron AI, Edwards JR, Patel J, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29(11):996–1011.

    Article  Google Scholar 

  2. Meşe EA, Altun D, Aydın A, Hekimoğlu CH. National Healthcare-associated Infections Surveillance Network. Ankara, Turkey: Ministry of Health of Turkey; 2019. Accessed 31 Aug 2020.

    Google Scholar 

  3. Gerberding J, Gaynes R, Horan T, Alonso-Echanove J, Edwards J, Emori G, et al. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992–April 2000, issued June 2000. Am J Infect Control. 2000;28(6):429–48.

    Article  Google Scholar 

  4. Noble WC, Virani Z, Cree RGA. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett. 1992;93(2):195–8.

    Article  CAS  Google Scholar 

  5. Olivier CN, Blake RK, Steed LL, Salgado CD. Risk of vancomycin-resistant enterococcus (VRE) bloodstream infection among patients colonized with VRE. Infect Control Hosp Epidemiol. 2008;29(5):404–9.

    Article  Google Scholar 

  6. Zaas AK, Song X, Tucker P, Perl TM. Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci. Clin Infect Dis. 2002;35(10):1139–46.

    Article  Google Scholar 

  7. Kapur D, Dorsky D, Feingold JM, et al. Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant. 2000;25(2):147–52.

    Article  CAS  Google Scholar 

  8. Roghmann M, McCarter RJ Jr., Brewrink J, Cross AS, Morris JG Jr.. Clostridium difficile infection is a risk factor for bacteremia due to vancomycin-resistant enterococci (VRE) in VRE-colonized patients with acute leukemia. Clin Infect Dis. 1997;25(5):1056–9.

    Article  CAS  Google Scholar 

  9. McNeil SA, Malani PN, Chenoweth CE, et al. Vancomycin-resistant enterococcal colonization and infection in liver transplant candidates and recipients: a prospective surveillance study. Clin Infect Dis. 2006;42(2):195–203.

    Article  Google Scholar 

  10. Se YB, Chun HJ, Yi HJ, Kim DW, Ko Y, Oh SJ. Incidence and risk factors of infection caused by vancomycin-resistant enterococcus colonization in neurosurgical intensive care unit patients. J Korean Neurosurg Soc. 2009;46(2):123–9.

    Article  Google Scholar 

  11. Bakir M, Bova JL, Newell KA, Michael Millis J, Buell JF, Arnow PM. Epidemiology and clinical consequences of vancomycin-resistant enterococci in liver transplant patients. Transplantation. 2001;72(6):1032–7.

    Article  CAS  Google Scholar 

  12. Brennen C, Wagener MM, Muder RR. Vancomycin-resistant Enterococcus faecium in a long-term care facility. J Am Geriatr Soc. 1998;46(2):157–60.

    Article  CAS  Google Scholar 

  13. Pan SC, Wang JT, Chen YC, Chang YY, Chen ML, Chang SC. Incidence of and risk factors for infection or colonization of vancomycin-resistant enterococci in patients in the intensive care unit. Plos One. 2012;7(10):1–8.

    Article  Google Scholar 

  14. Mutters NT, Brooke RJ, Frank U, Heeg K. Low risk of apparent transmission of vancomycin-resistant enterococci from bacteraemic patients to hospitalized contacts. Am J Infect Control. 2013;41(9):778–81.

    Article  Google Scholar 

  15. Özkaya-Parlakay A, Cengiz AB, Ceyhan M, et al. Vancomycin-resistant enterococcus colonization and infection in children: six-year follow-up. Turk J Pediatr. 2014;56(6):618–25.

    PubMed  Google Scholar 

  16. Kara A, Devrim I, Bayram N, et al. Risk of vancomycin-resistant enterococci bloodstream infection among patients colonized with vancomycin-resistant enterococci. Braz J Infect Dis. 2015;19(1):58–61.

    Article  Google Scholar 

  17. Habip G, Funda Ş, Arzu K, Taner Y, Deniz A, Demet A, et al. Vancomycin-resistant enterococci colonization in patients with hematological malignancies: screening and its cost-effectiveness. African Health Sciences. 2014;14:899–905.

    Article  Google Scholar 

  18. Ford CD, Lopansri BK, Gazdik MA, Snow GL, Webb BJ, Konopa KL, et al. The clinical impact of vancomycin-resistant Enterococcus colonization and bloodstream infection in patients undergoing autologous transplantation. Transplant Infectious Disease. 2015;17:688–94.

    Article  CAS  Google Scholar 

  19. Bossaer JB, Hall PD, Garrett-Mayer E. Incidence of vancomycin-resistant enterococci (VRE) infection in high-risk febrile neutropenic patients colonized with VRE. Supportive Care in Cancer. 2011;19:231–7.

    Article  Google Scholar 

  20. Lisboa LF, Miranda BG, Vieira MB, Dulley FL, Fonseca GG, Guimarães T, et al. Empiric use of linezolid in febrile hematology and hematopoietic stem cell transplantation patients colonized with vancomycin-resistant Enterococcus spp. International Journal of Infectious Diseases. 2015;33:e171–6.

    Article  Google Scholar 

  21. MacAllister TJ, Stohs E, Liu C, Bryan A, Whimbey E, Phipps A, et al. 10-year trends in vancomycin-resistant enterococci among allogeneic hematopoietic cell transplant recipients. Journal of Infection. 2018;77:38–46.

    Article  Google Scholar 

  22. Kamboj M, Chung D, Seo SK, Pamer EG, Sepkowitz KA, Jakubowski AA, et al. The Changing Epidemiology of Vancomycin-Resistant Enterococcus (VRE) Bacteremia in Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients. Biology of Blood and Marrow Transplantation. 2010;16:1576–81.

    Article  Google Scholar 

  23. Sütçü M, Akturk H, Acar M, Salman N, Aydin D, Akgun Karapinar B, et al. Impact of vancomycin-resistant enterococci colonization in critically ill pediatric patients. American Journal of Infection Control. 2016;44:515–9.

    Article  Google Scholar 

  24. Aktürk H, Sütçü M, Somer A, et al. Bir pediatrik hematoloji-onkoloji ünitesinde vankomisine dirençli enterokok kolonizasyon ve enfeksiyonu: Dört yillik sürveyans sonuçlari. Turk J Hematol. 2016;33(3):244–7.

    Article  Google Scholar 

  25. Matar MJ, Tarrand J, Raad I, Rolston KVI. Colonization and infection with vancomycin-resistant enterococcus among patients with cancer. Am J Infect Control. 2006;34(8):534–6.

    Article  Google Scholar 

  26. Patel R, Allen SL, Manahan JM, Wright AJ, Krom RAF, Wiesner RH, et al. Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients. Liver Transplantation. 2001;7:27–31.

    Article  CAS  Google Scholar 

  27. Montecalvo MA, Horowitz H, Gedris C, et al. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother. 1994;38(6):1363–7.

    Article  CAS  Google Scholar 

  28. Önlemler A. Outbreak of vancomycin resistant enterococci experience in Ege University Medical School. Turk Soc Hosp Infect Control. 2002;6:202–6.

    Google Scholar 

  29. Lucas GM, Lechtzin N, Puryear DW, Yau LL, Flexner CW, Moore RD. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis. 1998;26(5):1127–1127.

    Article  CAS  Google Scholar 

  30. Carmeli Y, Samore MH, Huskins WC. The association between antecedent vancomycin treatment and hospital-acquired vancomycin-resistant enterococci: a meta-analysis. Arch Intern Med. 1999;159(20):2461–8.

    Article  CAS  Google Scholar 

  31. Shay DK, Maloney SA, Montecalvo M, et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis. 1995;172(4):993–1000.

    Article  CAS  Google Scholar 

  32. Calderwood MS, Mauer A, Tolentino J, et al. Epidemiology of vancomycin-resistant enterococci among patients on an adult stem cell transplant unit: observations from an active surveillance program. Infect Control Hosp Epidemiol. 2008;29(11):1019–25.

    Article  Google Scholar 

  33. Correa AAF, Pignatari ACC, da Silveira M, Mingone RCC, de Sales Oliveira VG, Fortaleza CMCB. Small hospitals matter: insights from the emergence and spread of vancomycin-resistant enterococci in 2 public hospitals in inner Brazil. Diagn Microbiol Infect Dis. 2015;82(3):227–33.

    Article  Google Scholar 

  34. Metallidis S, Chatzidimitriou M, Tsona A, et al. Vancomycin-resistant enterococci, colonizing the intestinal tract of patients in a university hospital in Greece. Braz J Infect Dis. 2006;10(3):179–84.

    Article  Google Scholar 

  35. Karki S, Land G, Aitchison S, et al. Long-term carriage of vancomycin-resistant enterococci in patients discharged from hospitals: a 12-year retrospective cohort study. J Clin Microbiol. 2013;51(10):3374–9.

    Article  Google Scholar 

  36. Salgado CD, Farr BM. Outcomes associated with vancomycin-resistant enterococci: a meta-analysis. Infect Control Hosp Epidemiol. 2003;24(9):690–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Infectious Disease, Istanbul Training and Research Hospital, Istanbul, Turkey

    Abdurrahman Kaya MD

  2. Department of Infectious Disease, Sungurlu State Hospital, Çorum, Turkey

    Sibel Yıldız Kaya MD

  3. Department of Infectious Disease, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey

    Ilker Inanç Balkan MD,  Bilgül Mete MD,  Neşe Saltoglu MD &  Ömer Fehmi Tabak MD

  4. Istanbul Medicine Faculty, Public Health Department, Istanbul University, Istanbul, Turkey

    Osman Faruk Bayramlar MD

  5. Department of Medical Microbiolog, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey

    Gökhan Aygün MD

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  1. Abdurrahman Kaya MD
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Correspondence to Abdurrahman Kaya MD.

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A. Kaya, S.Y. Kaya, I.I. Balkan, O.F. Bayramlar, B. Mete, N. Saltoglu, G. Aygün and Ö.F. Tabak declare that they have no competing interests.

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Kaya, A., Kaya, S.Y., Balkan, I.I. et al. Risk factors for development of vancomycin-resistant enterococcal bacteremia among VRE colonizers. Wien Klin Wochenschr 133, 478–483 (2021). https://doi.org/10.1007/s00508-020-01733-7

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