Colonization With Vancomycin-Resistant Enterococci and Risk for Bloodstream Infection Among Patients With Malignancy: A Systematic Review and Meta-Analysis

Abstract

Background.Vancomycin-resistant enterococci (VRE) cause severe infections among patients with malignancy, and these infections are usually preceded by gastrointestinal colonization.Methods.We searched the PubMed and EMBASE databases (up to May 26, 2016) to identify studies that reported data on VRE gastrointestinal colonization among patients with solid or hematologic malignancy.Results.Thirty-four studies, reporting data on 8391 patients with malignancy, were included in our analysis. The pooled prevalence of VRE colonization in this population was 20% (95% confidence interval [CI], 14%–26%). Among patients with hematologic malignancy, 24% (95% CI, 16%–34%) were colonized with VRE, whereas no studies reported data solely on patients with solid malignancy. Patients with acute leukemia were at higher risk for VRE colonization (risk ratio [RR] = 1.95; 95% CI, 1.17–3.26). Vancomycin use or hospitalization within 3 months were associated with increased colonization risk (RR = 1.92, 95% CI = 1.06–3.45 and RR = 4.68, 95% CI = 1.66–13.21, respectively). Among the different geographic regions, VRE colonization rate was 21% in North America (95% CI, 13%–31%), 20% in Europe (95% CI, 9%–34%), 23% in Asia (95% CI, 13%–38%), and 4% in Oceania (95% CI, 2%–6%). More importantly, colonized patients were 24.15 (95% CI, 10.27–56.79) times more likely to develop a bloodstream infection due to VRE than noncolonized patients.Conclusions.A substantial VRE colonization burden exists among patients with malignancy, and colonization greatly increases the risk for subsequent VRE bloodstream infection. Adherence to antimicrobial stewardship is needed, and a re-evaluation of the use of vancomycin as empiric therapy in this patient population may be warranted.

Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis

“…On the other hand, our finding was lower than studies reported from North America (21%), Asia (24%) and Europe (20%) [52]. Another study from Iran reported high rate of VRE (48.9%) among hospitalized patients [53].…”

“…Stool, urine and blood were the most common specimens from which VRE were isolated. This is not surprising because enterococci have been reported as the most common organisms isolated from intestinal tract, urinary tract and blood stream infections [5,8,15,20,48,52,57,62].…”

Challenges in Infectious Diseases for Haematologists

“…The clinical significance of most MDR has not been fully determined, but they are usually assumed to be more threatening than their susceptible counterparts. For example, colonisation [5] and infection [6] with vancomycin-resistant enterococci may have a negative impact on outcome in cancer patients. In contrast, bacteraemia caused by methicillin-resistant Staphylococcus aureus may not be more dangerous than bacteraemia caused by susceptible strains [7,] whereas there is strong evidence that carbapenemase-producing Klebsiella spp.…”

Timepoints of vancomycin‐resistant Enterococcus colonization predict outcomes of acute myeloid leukemia patients undergoing allogeneic hematopoietic cell transplantation

“…with VRE leads to an intestinal domination with Enterococci 31,32 and 100% 1,35,36. Based on this, it seems likely that previously VRE colonized might also have no increased risk for VRE infections.…”

“…(VRE) is a frequent burden in patients with hematological malignancies worldwide. 1 Enterococci, mainly Enterococcus faecalis and Enterococcus faecium, are common commensals of the human intestine. However, they can cause severe infections such as urinary tract infections, blood stream infections, hepatobiliary sepsis, and endocarditis.…”