Case-case-control study on factors associated with vanB vancomycin-resistant and vancomycin-susceptible enterococcal bacteraemia

Abstract

BackgroundEnterococci are a major cause of healthcare-associated infection. In Australia, vanB vancomycin-resistant enterococci (VRE) is the predominant genotype. There are limited data on the factors linked to vanB VRE bacteraemia. This study aimed to identify factors associated with vanB VRE bacteraemia, and compare them with those for vancomycin-susceptible enterococci (VSE) bacteraemia.MethodsA case-case-control study was performed in two tertiary public hospitals in Victoria, Australia. VRE and VSE bacteraemia cases were compared with controls without evidence of enterococcal bacteraemia, but may have had infections due to other pathogens.ResultsAll VRE isolates had vanB genotype. Factors associated with vanB VRE bacteraemia were urinary catheter use within the last 30 days (OR 2.86, 95% CI 1.09-7.53), an increase in duration of metronidazole therapy (OR 1.65, 95% CI 1.17-2.33), and a higher Chronic Disease Score specific for VRE (OR 1.70, 95% CI 1.05-2.77). Factors linked to VSE bacteraemia were a history of gastrointestinal disease (OR 2.29, 95% CI 1.05-4.99) and an increase in duration of metronidazole therapy (OR 1.23, 95% CI 1.02-1.48). Admission into the haematology/oncology unit was associated with lower odds of VSE bacteraemia (OR 0.08, 95% CI 0.01-0.74).ConclusionsThis is the largest case-case-control study involving vanB VRE bacteraemia. Factors associated with the development of vanB VRE bacteraemia were different to those of VSE bacteraemia.

Risk factors and medical costs for healthcare-associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital

“…There is a close association between healthcare-associated infection and antibiotic use [30–33], especially carbapenem exposure. Thus, in order to more accurately characterize the antibiotic exposure in our study, we assessed the treatment with antibiotics in the 3 months before infection for the case patients and control patients, in this timeframe for data collection is longer than that of other studies [4].…”

S2k-Leitlinie Gastrointestinale Infektionen und Morbus Whipple

“…Auf der anderen Seite zeigte sich in Beobachtungs-und Fallkontrollstudien auch bei einer Metronidazoltherapie ein gehäuftes Auftreten von Haut-und Umgebungskontaminationen mit VRE bzw. einer VRE-Bakteriämie [166,167]. Auch war in einer prospektiven Studie war eine Metronidazoltherapie mit der Persistenz einer vorbestehenden VRE-Kolonisation assoziiert [168].…”

Epidemiology, treatment and outcomes of bloodstream infection due to vancomycin-resistant enterococci in cancer patients in a vanB endemic setting

“…Vancomycin-resistant enterococci (VRE) contribute significantly to the burden of healthcare-associated infections, particularly among immunocompromised patient populations [1][2][3]. Outcomes of infection include higher mortality [4][5][6][7] and prolonged hospitalisation [1,8].…”

“…Studies evaluating risks for BSI and clinical outcomes have focussed on vanA VRE as the predominant genotype or have been performed in settings where vanA strains are dominant [2,10]. Although there have been recent reports of increased vanA in Australia, vanB has historically been the predominant genotype [9].…”