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

Abstract

Background: Vancomycin-resistant enterococcus (VRE) is an important cause of infection in immunocompromised populations. Few studies have described the characteristics of vanB VRE infection. We sought to describe the epidemiology, treatment and outcomes of VRE bloodstream infections (BSI) in a vanB predominant setting in malignant hematology and oncology patients. Methods: A retrospective review was performed at two large Australian centres and spanning a 6-year period (2008-2014). Evaluable outcomes were intensive care admission (ICU) within 48 h of BSI, all-cause mortality (7 and 30 days) and length of admission. Results: Overall, 106 BSI episodes were observed in 96 patients, predominantly Enterococcus faecium vanB (105/106, 99%). Antibiotics were administered for a median of 17 days prior to BSI, and 76/96 (79%) were neutropenic at BSI onset. Of patients screened before BSI onset, 49/72 (68%) were found to be colonised. Treatment included teicoplanin (59), linezolid (6), daptomycin (2) and sequential/multiple agents (21). Mortality at 30-days was 31%. On multivariable analysis, teicoplanin was not associated with mortality at 30 days. Conclusions: VRE BSI in a vanB endemic setting occurred in the context of substantive prior antibiotic use and was associated with high 30-day mortality. Targeted screening identified 68% to be colonised prior to BSI. Teicoplanin therapy was not associated with poorer outcomes and warrants further study for vanB VRE BSI in cancer populations.

Urinary Tract Infections in Elderly Patients: A 10-Year Study on Their Epidemiology and Antibiotic Resistance Based on the WHO Access, Watch, Reserve (AWaRe) Classification

“…Additionally, their study noted that CR-UTIs were more common in patients aged over 65, and were associated with adverse clinical outcomes (higher rates of subsequent bacteremia, longer hospital stay and recurrence). Due to the reportedly high prevalence of Enterococcus spp., one should prepare for the possibility of encountering vancomycin-resistant variants (VRE), with a global prevalence ranging between 0–18% (5–30% in Intensive Care Units) [ 47 ]: while in case of E. faecalis , susceptibility to ampicillin (and other β-lactams) and aminoglycosides is usually retained, E. faecium is highly resistant to these drugs, therefore guidelines recommend therapy with either linezolid or daptomycin, depending on the clinical situation [ 48 ].…”

Intensive Care Outcomes of Patients after High Dose Chemotherapy and Subsequent Autologous Stem Cell Transplantation: A Retrospective, Single Centre Analysis

“…Patients in cohort 1 had more antibiotic resistant bacteria detected in their total hospital stay (four vancomycin-resistant enterococcus, two extended spectrum β-lactamase producing bacteria) compared to cohort 2 (one vancomycin-resistant enterococcus and one extended spectrum β-lactamase producing bacteria), which required an extended antibiotic treatment regime. This high prevalence of resistant organisms might be associated with a more severe course of disease [ 22 , 23 ]. Interestingly, patients who had been admitted to the ICU within 6 months of successful treatment (cohort 2) were still susceptible for severe fungal infection.…”

Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward

“…57,58 However, widespread and prolonged use of broad-spectrum antibiotics to reduce mortality and morbidity from infections in patients with cancer are likely contributors to the emergence of resistance. [59][60][61] In addition, patients with cancer are vulnerable to health care-acquired infections as a major source of antibioticresistant organisms. 32,62,63 We have summarized several studies in which ESKAPE pathogens were isolated from patients with cancer since 2015 in Table 2.…”