Incidence of vancomycin-resistant enterococci (VRE) infection in high-risk febrile neutropenic patients colonized with VRE

Bossaer, John B.; Hall, Philip D.; Garrett‐Mayer, Elizabeth

doi:10.1007/s00520-009-0808-y

Cited by 56 publications

(33 citation statements)

References 17 publications

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“…Septicemia is the most life-threatening infection after allogeneic SCT and gram-negative rods are the most dominant pathogens of septicemia, whereas incidence of drug-resistant enterococci infection increase in neutropenic patients colonized with these bacteria in some centers. 1 GVHD is one of the major predisposing factors for the development of septicemia. 2 Since the pioneering works of van Bekkum 3 and others in the 1960s-1970s, interaction between intestinal flora and GVHD has been suggested.…”

Section: Introductionmentioning

confidence: 99%

Graft-versus-host disease disrupts intestinal microbial ecology by inhibiting Paneth cell production of α-defensins

Eriguchi

Takashima

Oka

et al. 2012

Blood

284

270

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AbstractAllogeneic hematopoietic stem cell transplantation (SCT) is a curative therapy for various hematologic disorders. Graft-versus-host disease (GVHD) and infections are the major complications of SCT, and their close relationship has been suggested. In this study, we evaluated a link between 2 complications in mouse models. The intestinal microbial communities are actively regulated by Paneth cells through their secretion of antimicrobial peptides, α-defensins. We discovered that Paneth cells are targeted by GVHD, resulting in marked reduction in the expression of α-defensins, which selectively kill noncommensals, while preserving commensals. Molecular profiling of intestinal microbial communities showed loss of physiologic diversity among the microflora and the overwhelming expansion of otherwise rare bacteria Escherichia coli, which caused septicemia. These changes occurred only in mice with GVHD, independently on conditioning-induced intestinal injury, and there was a significant correlation between alteration in the intestinal microbiota and GVHD severity. Oral administration of polymyxin B inhibited outgrowth of E coli and ameliorated GVHD. These results reveal the novel mechanism responsible for shift in the gut flora from commensals toward the widespread prevalence of pathogens and the previously unrecognized association between GVHD and infection after allogeneic SCT.

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Section: Introductionmentioning

confidence: 99%

Graft-versus-host disease disrupts intestinal microbial ecology by inhibiting Paneth cell production of α-defensins

Eriguchi

Takashima

Oka

et al. 2012

Blood

284

270

View full text Add to dashboard Cite

show abstract

“…Kim and colleagues 27 described a prospective study in an intensive care unit in which 9.2% (17/184) of VRE-colonized patients experienced VRE sterile-site infections. In a study of high-risk patients with febrile neutropenia, Bossaer and coworkers 18 showed a 26.4% rate (14/53) of VRE bloodstream infection in VRE-colonized patients. Finally, Ford and colleagues 17 found that 12.2% (10/82) of VRE-colonized patients with leukemia later experienced a VRE bloodstream infection.…”

Section: Discussionmentioning

confidence: 99%

“…14 Previous studies have evaluated the predictive value of VRE screening swabs in forecasting the prevalence of VRE among all causes of bacterial infection. [15][16][17][18][19] In this study, we sought to investigate the utility of results obtained with VRE screening swabs in predicting vancomycin resistance among subsequent sterile-site infections with Enterococcus. We hypothesized that among patients with sterile-site Enterococcus infections, prior positive results with VRE screening swabs would reliably predict vancomycin resistance, but prior negative results would not reliably rule out vancomycin resistance.…”

mentioning

confidence: 99%

Predictive utility of swab screening for vancomycin-resistant Enterococcus in selection of empiric antibiotics for Enterococcus sterile-site infections: a retrospective cohort study

et al. 2017

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“…5,8,9,30,31,[33][34][35] The most important risk factor for infection with resistant pathogens is prior colonization or infection by resistant organisms (Table 2). This applies for ESBL-and carbapenemase-producing Enterobacteriaceae; A. baumannii, P. aeruginosa, S. maltophilia; methicillin-resistant Staphylococcus aureus (MRSA) and VRE 8,9,31,[35][36][37][38][39][40][41][42][43] with recent reports also in the case of colistin-resistant K. pneumoniae. Administration of broad-spectrum antibiotics for prophylaxis and management of fever and neutropenia within months, especially within the last month, before current infectious episode, may be associated with subsequent infection with resistant bacteria.…”

Section: Importance Of Appropriate Initial Antibiotic Therapy In Febrmentioning

confidence: 99%

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

et al. 2013

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Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4 th European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'deescalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance. ABSTRACT© F e r r a t a S t o r t i F o u n d a t i o n 2 0 1 3 increasing resistance. The draft of these guidelines was discussed by the Expert Group at the ECIL-4 meeting in September 2011 and considers: i) bacterial epidemiology in neutropenic patients; ii) risk factors for resistance; iii) escalation and deescalation approaches; iv) the appropriate duration of empirical therapy; iv) non-conventional therapies against multi-resistant pathogens; and v) other issues on the management of bacterial infections in these patients. Up-dated slide sets from ECIL-4 covering these aspects are available on the websites of the four organizations involved in ECIL: the European Group for Blood and Marrow Transplantation, the European Organisation for Research and Treatment of Cancer, the Immunocompromised Host Society (ECIL), and the European Leukaemia Net. 12,13 This article summarizes the main ECIL recommendations on the initial empirical therapy of bacterial infections, but will also be valuable for the management of the many nonneutropenic but severely-immunosuppressed hematology patients. MethodsThe methodology of the ECIL conferences has been described previously. 11A working group of experts in the field of infectious diseases, microbiology or hematology was constituted, and reviewed the published literature in order to prepare proposals covering the following aspects: 1) empirical antibiotic therapy for...

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Incidence of vancomycin-resistant enterococci (VRE) infection in high-risk febrile neutropenic patients colonized with VRE

Cited by 56 publications

References 17 publications

Graft-versus-host disease disrupts intestinal microbial ecology by inhibiting Paneth cell production of α-defensins

Graft-versus-host disease disrupts intestinal microbial ecology by inhibiting Paneth cell production of α-defensins

Predictive utility of swab screening for vancomycin-resistant Enterococcus in selection of empiric antibiotics for Enterococcus sterile-site infections: a retrospective cohort study

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

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