Consequences of vancomycin‐resistant <i>Enterococcus</i> in liver transplant recipients: a matched control study

Gearhart, Michelle M.; Martin, Jill E.; Rudich, Steven; Thomas, Mark J.; Wetzel, Dave; Solomkin, Joseph S.; Hanaway, Michael J.; Aranda-Michel, Jaime; Weber, F.Parkes; Trumball, Leslie; Bass, Maryetta; Zavala, E; Woodle, E. Steve; Buell, Joseph F.

doi:10.1111/j.1399-0012.2005.00362.x

Cited by 59 publications

(59 citation statements)

References 13 publications

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“…Eighteen studies were eligible for inclusion including: 5 multicenter studies reporting the incidence of VRE infections [2,[13][14][15][16] and 13 studies (4 multicenter and 9 single center) evaluating relevant outcomes [17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Resultsmentioning

confidence: 99%

Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

Chiang

Perencevich

Nair

et al. 2016

Infect. Control Hosp. Epidemiol.

100

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Section: Resultsmentioning

confidence: 99%

Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

Chiang

Perencevich

Nair

et al. 2016

Infect. Control Hosp. Epidemiol.

100

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“…Effective antibiotic therapy has been shown to reduce mortality from VRE-BSI (13). However, the high attributable mortality associated with VRE-BSI in cohorts of hematopoietic stem cell transplant recipients, liver transplant patients, oncology patients, and inpatient populations (11)(12)(13)(14)(15)(16)(17)(18)(19) warrants an examination of the literature to examine which therapies may be associated with improved clinical outcomes in these vulnerable populations.…”

Section: Discussionmentioning

confidence: 99%

“…VRE-BSI are associated with significant mortality in cohorts of hematopoietic stem cell transplant recipients, liver transplant patients, oncology patients, and other inpatient populations (11)(12)(13)(14)(15)(16)(17)(18)(19). Importantly, effective antibiotic therapy and shorter duration of bacteremia are associated with lower mortality in patients with VRE-BSI (11,(19)(20)(21)(22).…”

mentioning

confidence: 99%

“…VRE-BSI primarily affect the most vulnerable patient populations, including postsurgical and trauma patients, complex internal medicine patients, and those who have undergone organ transplantation, especially liver transplantation (7)(8)(9)(10)(11)(12). VRE-BSI are associated with significant mortality in cohorts of hematopoietic stem cell transplant recipients, liver transplant patients, oncology patients, and other inpatient populations (11)(12)(13)(14)(15)(16)(17)(18)(19).…”

mentioning

confidence: 99%

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Systematic Review and Meta-Analysis of Linezolid and Daptomycin for Treatment of Vancomycin-Resistant Enterococcal Bloodstream Infections

Whang

Miller

Partain

et al. 2013

Antimicrob Agents Chemother

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Bloodstream infections due to vancomycin-resistant enterococci (VRE-BSI) result in substantial patient mortality and cost. Daptomycin and linezolid are commonly prescribed for VRE-BSI, but there are no clinical trials to determine optimal antibiotic selection. We conducted a systematic review for investigations that compared daptomycin and linezolid for VRE-BSI. We searched Medline from 1966 through 2012 for comparisons of linezolid and daptomycin for VRE-BSI. We included searches of EMBASE, clinicaltrials.gov, and national meetings. Data were extracted using a standardized instrument. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using a fixed-effects model. Our search yielded 4,243 publications, of which 482 contained data on VRE treatment. Most studies (452/482) did not present data on BSI or did not provide information on linezolid or daptomycin. Among the remaining 30 studies, 9 offered comparative data between the two agents. None were randomized clinical trials. There was no difference in microbiologic (n ‫؍‬ 5 studies, 517 patients; OR, 1.0; 95% CI, 0.4 to 1.7; P ‫؍‬ 0.95) and clinical (n ‫؍‬ 3 studies, 357 patients; OR, 1.2; 95% CI, 0.7 to 2.0; P ‫؍‬ 0.7) cures between the two antibiotics. There was a trend toward increased survival with linezolid compared to daptomycin treatment (n ‫؍‬ 9 studies, 1,074 patients; OR, 1.3; 95% CI, 1.1 to 1.8; I 2 ‫؍‬ 0 [where I 2 is a measure of inconsistency]), but this did not reach statistical significance (P ‫؍‬ 0.054). There are limited data to inform clinicians on optimal antibiotic selection for VRE-BSI. Available studies are limited by small sample size, lack of patient-level data, and inconsistent outcome definitions. Additional research, including randomized clinical trials, is needed before conclusions can be drawn about treatment options for VRE therapy.

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“…In a large meta-analysis of the outcomes of VRE infections, Salgado and Farr postulated that one of the reasons for the increased mortality in these patients was delayed effective antimicrobial therapy against VRE (28). Patients at the greatest risk for VRE are most likely to be critically ill and solid-organ transplant recipients and to have prolonged neutropenia and/or to have spent prolonged periods in the hospital (5,6,13,15,28,39). Early appropriate antimicrobial therapy has been demonstrated to improve patient outcomes in the intensive-care unit (ICU) setting, which is clearly a high-risk setting for VRE infection (16,30).…”

mentioning

confidence: 99%

Peptide Nucleic Acid Fluorescent In Situ Hybridization for Hospital-Acquired Enterococcal Bacteremia: Delivering Earlier Effective Antimicrobial Therapy

Forrest

Roghmann

Toombs

et al. 2008

Antimicrob Agents Chemother

164

117

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Hospital-acquired vancomycin-resistant enterococcal bacteremia has been associated with increased hospital costs, length of stay, and mortality. The peptide nucleic acid fluorescent in situ hybridization (PNA FISH) test for Enterococcus faecalis and other enterococci (EFOE) is a multicolor probe that differentiates E. faecalis from other enterococcal species within 3 h directly from blood cultures demonstrating gram-positive cocci in pairs and chains (GPCPC). A quasiexperimental study was performed over two consecutive years beginning in 2005 that identified GPCPC by conventional microbiological methods, and in 2006 PNA FISH was added with a treatment algorithm developed by the antimicrobial team (AMT). The primary outcome assessed was the time from blood culture draw to the implementation of effective antimicrobial therapy before and after PNA FISH. The severity of illness, patient location, and empirical antimicrobial therapy were measured. A total of 224 patients with hospital-acquired enterococcal bacteremia were evaluated, with 129 in the preintervention period and 95 in the PNA FISH period. PNA FISH identified E. faecalis 3 days earlier than conventional cultures (1.1 versus 4.1 days; P < 0.001). PNA FISH identified Enterococcus faecium a median 2.3 days earlier (1.1 versus 3.4 days; P < 0.001) and was associated with statistically significant reductions in the time to initiating effective therapy (1.3 versus 3.1 days; P < 0.001) and decreased 30-day mortality (26% versus 45%; P ‫؍‬ 0.04). The EFOE PNA FISH test in conjunction with an AMT treatment algorithm resulted in earlier initiation of appropriate empirical antimicrobial therapy for patients with hospital-acquired E. faecium bacteremia.Enterococcal bacteremia is the fourth most common cause of hospital-acquired bacteremia within the United States and the fifth most common in Europe according to the SENTRY antimicrobial surveillance program (2). The predominant enterococcal species that cause these infections are Enterococcus faecalis and Enterococcus faecium (28,38). Vancomycin-resistant enterococci (VRE) have emerged as a major problem and have progressively increased over the last decade. The most recent surveillance data from SENTRY showed that E. faecium resistance to vancomycin had increased from 40% to 61% in 2002, while the Surveillance and Control of Pathogens of Epidemiologic Importance survey also found 40% vancomycin-resistant E. faecium in 2002 (2, 38). At many tertiary-care medical centers, E. faecium is approaching nearly 100% vancomycin resistance (1,22,40). In contrast, E. faecalis has maintained susceptibility to ampicillin with a relatively small increase in vancomycin resistance (1, 37).

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Consequences of vancomycin‐resistant Enterococcus in liver transplant recipients: a matched control study

Abstract: VRE was associated with prior antibiotic use, multiple abdominal surgeries, biliary complications and resulted in decreased survival compared to non-VRE control patients. VRE patients also utilized more hospital resources. Linezolid showed a trend toward improved survival.

Cited by 59 publications

References 13 publications

Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

Systematic Review and Meta-Analysis of Linezolid and Daptomycin for Treatment of Vancomycin-Resistant Enterococcal Bloodstream Infections

Peptide Nucleic Acid Fluorescent In Situ Hybridization for Hospital-Acquired Enterococcal Bacteremia: Delivering Earlier Effective Antimicrobial Therapy

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