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

Chiang, Hsiu‐Yin; Perencevich, Eli N.; Nair, Rajeshwari; Nelson, Richard E.; Samore, Matthew H.; Khader, Karim; Chorazy, Margaret L.; Herwaldt, Loreen A.; Blevins, Amy; Ward, Melissa; Schweizer, Marin L.

doi:10.1017/ice.2016.254

Cited by 104 publications

(73 citation statements)

References 42 publications

(140 reference statements)

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“…104 Vancomycin-resistant enterococci (VREs) are the second most common cause of antibiotic resistant nosocomial infection behind only methicillin resistant S. aureus (MRSA). 105 …”

Section: Enterococcus Faeciummentioning

confidence: 99%

Nonribosomal peptide synthetase biosynthetic clusters of ESKAPE pathogens

Gulick

2017

Nat. Prod. Rep.

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Overview Natural products are important secondary metabolites produced by bacterial and fungal species that play important roles in cellular growth and signaling, nutrient acquisition, intra- and interspecies communication, and virulence. A subset of natural products is produced by nonribosomal peptide synthetases (NRPSs), a family of large, modular enzymes that function in an assembly line fashion. Because of the pharmaceutical activity of many NRPS products, much effort has gone into the exploration of their biosynthetic pathways and the diverse products they make. Many interesting NRPS pathways have been identified and characterized from both terrestrial and marine bacterial sources. Recently, several NRPS pathways in human commensal bacterial species have been identified that produce molecules with antibiotic activity, suggesting another source of interesting NRPS pathways may be the commensal and pathogenic bacteria that live on the human body. The ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) have been identified as a significant cause of human bacterial infections that are frequently multidrug resistant. The emerging resistance profile of these organisms has prompted calls from multiple international agencies to identify novel antibacterial targets and develop new approaches to treat infections from ESKAPE pathogens. Each of these species contains several NRPS biosynthetic gene clusters. While some have been well characterized and produce known natural products with important biological roles in microbial physiology, others have yet to be investigated. This review catalogs the NRPS pathways of ESKAPE pathogens. The exploration of novel NRPS products may lead to a better understanding of the chemical communication used by human pathogens and potentially to the discovery of novel therapeutic approaches.

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“…104 Vancomycin-resistant enterococci (VREs) are the second most common cause of antibiotic resistant nosocomial infection behind only methicillin resistant S. aureus (MRSA). 105 …”

Section: Enterococcus Faeciummentioning

confidence: 99%

Nonribosomal peptide synthetase biosynthetic clusters of ESKAPE pathogens

Gulick

2017

Nat. Prod. Rep.

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“…In addition to colistin-resistant Enterobacteriaceae , the detection of vancomycin-resistant enterococci isolates is of clinical concern. The prevalence of VRE strains is increasing in Europe, especially Enterococcus faecium [ 25 ] and has led to nosocomial infections in the United States [ 26 ], and their dissemination is associated with high mortality rates [ 27 ]. The development of an effective screening tool for the early detection of those multi-drug resistant pathogens has become a priority, in order to adapt treatment and isolate patients who are either infected or carriers.…”

Section: Introductionmentioning

confidence: 99%

LBJMR medium: a new polyvalent culture medium for isolating and selecting vancomycin and colistin-resistant bacteria

et al. 2017

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BackgroundMulti-drug resistant bacteria are a phenomenon which is on the increase around the world, particularly with the emergence of colistin-resistant Enterobacteriaceae and vancomycin-resistant enterococci strains. The recent discovery of a plasmid-mediated colistin resistance with the description of the transferable mcr-1 gene raised concerns about the need for an efficient detection method for these pathogens, to isolate infected patients as early as possible. The LBJMR medium was developed to screen for all polymyxin-resistant Gram-negative bacteria, including mcr-1 positive isolates, and vancomycin-resistant Gram-positive bacteria.ResultsThe LBJMR medium was developed by adding colistin sulfate salt at a low concentration (4 μg/mL) and vancomycin (50 μg/mL), with glucose (7.5 g/L) as a fermentative substrate, to a Purple Agar Base (31 g/L). A total of 143 bacterial strains were used to evaluate this universal culture medium, and the sensitivity and specificity of detection were 100% for the growth of resistant strains. 68 stool samples were cultured on LBJMR, and both colistin-resistant Gram-negative and vancomycin-resistant Gram-positive strains were specifically detected.ConclusionsThe LBJMR medium is a multipurpose selective medium which makes it possible to identify bacteria of interest from clinical samples and to isolate contaminated patients in hospital settings. This is a simple medium that could be easily used for screening in clinical microbiology laboratories.Electronic supplementary materialThe online version of this article (10.1186/s12866-017-1128-x) contains supplementary material, which is available to authorized users.

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“…Vancomycin-resistant enterococci (VRE) are emerging worldwide and are among the most common antimicrobial-resistant pathogens causing nosocomial infections [ 1 – 4 ]. Since infections with VRE are associated with prolonged in-hospital stay and excess mortality [ 5 , 6 ], increasing VRE rates pose a serious threat to global health. In fact, the World Health Organization (WHO) judged VRE to be of high importance in the “Global Priority list of antibiotic-resistant bacteria to guide research, discovery and development of new antibiotics” [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of antibiotic use on prevalence of nosocomial vancomycin-resistant enterococci- an ecologic study

Remschmidt

Behnke

Kola

et al. 2017

Antimicrob Resist Infect Control

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BackgroundVancomycin-resistant enterococci (VRE) are among the most common antimicrobial-resistant pathogens causing nosocomial infections. Although antibiotic use has been identified as a risk factor for VRE, it remains unclear which antimicrobial agents particularly facilitate VRE selection. Here, we assessed whether use of specific antimicrobial agents is independently associated with healthcare-associated (HA) VRE rates in a university hospital setting in Berlin, Germany.MethodsWe conducted the study between January 2014 and December 2015 at the Charité-university hospital of Berlin, Germany. From the hospital pharmacy, we extracted data for all antibacterials for systemic use (anatomical therapeutic chemical (ATC)-classification J01) and calculated ward specific antibiotic consumption in defined daily doses (DDDs) per 100 patient-days (PD). We used the microbiology laboratory database to identify all patients with isolation of invasive or non-invasive VRE and calculated HA-VRE incidence as nosocomial VRE-cases per 100 patients and HA-VRE incidence density as nosocomial VRE-cases per 1000 PD. We defined VRE isolates as hospital-acquired if they were identified three days or later after hospital admission and otherwise as community-acquired (CA-VRE). We performed univariable and multivariable regression analyses to estimate the association of the frequency of HA-VRE per month with antibiotic use and other parameters such as length of stay, type of ward or presence of at least one CA-VRE on ward. In a second analysis, we considered only patients with VRE infections.ResultsWe included data from 204,054 patients with 948,380 PD from 61 wards. Overall, 1430 VRE-cases were identified of which 409 (28.6%) were considered hospital-acquired (HA). We found that carbapenem use in the current month and prior-month use of glycopeptides increased the risk for HA-VRE by 1% per 1 DDD/100 PD and 3% per 1 DDD/100 PD, respectively. However, when only VRE from clinical samples were considered, only glycopeptide use showed a statistically significant association. In both models, detection of at least one patient with CA-VRE on a ward in the current month significantly increased the risk of HA-VRE, thereby indicating nosocomial spread of VRE.ConclusionsOur findings suggest that the risk of HA-VRE is associated with specific antimicrobial agents. Prudent use of these antimicrobial agents might reduce nosocomial VRE rates. That appearance of at least one CA-VRE case on the ward increased the risk of HA-VRE detection highlights the importance of strict hand hygiene practices to interrupt person-to-person transmission of VRE.

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

Abstract: Background: Information about the health and economic impact of infections caused by vancomycin-

Cited by 104 publications

References 42 publications

Nonribosomal peptide synthetase biosynthetic clusters of ESKAPE pathogens

Nonribosomal peptide synthetase biosynthetic clusters of ESKAPE pathogens

LBJMR medium: a new polyvalent culture medium for isolating and selecting vancomycin and colistin-resistant bacteria

The effect of antibiotic use on prevalence of nosocomial vancomycin-resistant enterococci- an ecologic study

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