Risk Factors for Development of Vancomycin‐Resistant Enterococcal Bloodstream Infection in Patients with Cancer Who Are Colonized with Vancomycin‐Resistant Enterococci

Zaas, Aimee K.; Song, Qinbao; Tucker, Pamela C.; Perl, Trish M.

doi:10.1086/342904

Cited by 130 publications

(110 citation statements)

References 27 publications

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“…Ten of 12 patients experienced VRE BSI during the neutropenic period (median 15 days post transplant, range [8][9][10][11][12][13][14][15][16][17][18][19][20][21], and mainly this occurred in patients with refractory or relapsed disease at the time of transplantation (70%). All VRE BSI patients were co-infected with other organisms including gram-negative bacilli, fungi or CMV, and five patients had intra-abdomial complications (GVHD, cholecystitis or typhlitis).…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Up to 73% of enterococcal BSIs are due to vancomycin-resistant strains. 9 Risk factors for vancomycin-resistant enterococcal (VRE) colonization and infection include prolonged hospitalization, intensive care unit (ICU) stay, advanced age, immunocompromised state, neutropenia, high severity of underlying illness, antibiotic exposure, and indwelling urinary and vascular catheters, 8,[10][11][12][13] characteristics commonly found in patients on HSCT units. Several studies have investigated the significance of VRE infections in different patient populations and controversy exists as to whether VRE infections are associated with worse outcomes compared to vancomycin-sensitive enterococci.…”

Section: Introductionmentioning

confidence: 99%

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Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?

Dubberke

Hollands

Georgantopoulos

et al. 2006

Bone Marrow Transplant

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Patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients are at high risk for bacterial bloodstream infections (BSI) owing to resistant organisms. Data describing the outcomes of vancomycin-resistant enterococcal (VRE) BSI in this patient population are limited. We performed a retrospective cohort study of all cases of VRE BSI that occured between February 1996 and December 2002 on the Leukemia/HSCT unit at Barnes-Jewish Hospital. There were 68 episodes of VRE BSI in 60 patients with acute (53%) or chronic (8%) leukemia, non-Hodgkin's lymphoma (22%) or other malignant hematologic disorders (17%). A total of 13, 32 and 32% were recipients of autologous, related and matched-unrelated transplants, respectively. Forty-two of allograft recipients had active acute graft-versus-host disease (GVHD) and 32% chronic GVHD. Only 57% were neutropenic, 52% had refractory/relapsed malignancy and 60% had end organ dysfunction with a median APACHE II score of 17. Median survival after VRE BSI was 19 days. Pneumonia, receipt of anti-fungal drugs and low APACHE II score at the time of the VRE BSI remained significant risk factors for death on multivariable analysis. Our analysis suggests that in patients with hematological malignancies or HSCT, VRE may not have the behavior of a virulent pathogen. VRE BSI may simply be a marker of these patients' already existing critical medical condition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?

Dubberke

Hollands

Georgantopoulos

et al. 2006

Bone Marrow Transplant

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“…Interestingly, Zaas et al found that diabetes was a risk factor for development of bloodstream infections with VREF in patients with cancer who were colonized with VREF (31). In addition, other factors such as underlying illnesses, compliance with infection control measures, proximity to other VREFcolonized patients, and prolonged or repetitive hospitalization have been reported to affect acquisition of VREF (3,5,8,16,20,31).…”

Section: Discussionmentioning

confidence: 99%

Acquisition and Duration of Vancomycin-Resistant Enterococcal Carriage in Relation to Strain Type

Mascini¹,

Jalink²,

Kamp-Hopmans³

et al. 2003

J Clin Microbiol

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In May 2000, the first outbreak of vancomycin-resistant Enterococcus faecium (VREF) was detected in the University Medical Center Utrecht in the nephrology ward. The question arose why some VREF strains spread among hospitalized patients, whereas other strains do not. Thirty patients who were found to be colonized with VREF between May and November 2000 were included in the study. Molecular typing confirmed that 19 of them carried an identical epidemic strain which harbored the esp gene while 11 were colonized by nonepidemic strains that were all esp negative. Acquisition of the outbreak strain was significantly associated with diabetes mellitus, renal transplantation, and extensive use of antibiotics, especially cephalosporins, in the 2-month period before the first isolation of VREF. To establish the duration of colonization, prospective surveillance of VREF carriage for a 6-month period starting from the first isolation of VREF was realized for 20 patients. After 6 months, VREF was still recovered from 60% of carriers of the outbreak strain versus 20% of carriers of nonepidemic strains (P < 0.01). However, antibiotic use during the follow-up period was significantly higher by carriers of the outbreak strain than by carriers of nonepidemic strains. The fact that the outbreak strain was recovered for a longer period of time than nonepidemic strains may facilitate dissemination of the strain. The results support a careful restrictive antibiotic policy for wards at risk for spread of VREF and implementation of isolation precautions for patients who are colonized with esp-positive outbreak strains.

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“…Liver transplant patients and patients with hematologic malignancies are at particular risk for severe disease (3,6,7). The prevalence of VRE colonization increases with age and exposure to antibiotics (2).…”

mentioning

confidence: 99%

Evaluation of a Chromogenic Agar under Development To Screen for VRE Colonization

2010

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BBL CHROMagar VanRE (CVRE) was compared with bile esculin azide agar plus vancomycin to screen for vancomycin-resistant enterococcus (VRE) colonization. CVRE distinguishes Enterococcus faecalis (green colonies) from Enterococcus faecium (mauve colonies) on the basis of chromogenic substrate use. CVRE sensitivity and specificity were 98.6% and 99.1%. Positive and negative predictive values were 95.9% and 99.7%.Vancomycin-resistant enterococci (VRE) commonly colonize the gastrointestinal tract of humans and can cause outbreaks of increased colonization rates and occasional extraintestinal infections, including bacteremia and peritonitis in pediatric, elderly, or immunocompromised patients (2). Liver transplant patients and patients with hematologic malignancies are at particular risk for severe disease (3, 6, 7). The prevalence of VRE colonization increases with age and exposure to antibiotics (2). Treatment regimens that include exposure of patients to cephalosporins or glycopeptides that eradicate normal bowel flora often allow VRE to proliferate. Although the practice is controversial (4), many hospitals as a part of their infection prevention measures currently screen at-risk patients for VRE colonization. Contact precautions are typically implemented for VRE-colonized patients to control nosocomial spread of VRE among noncolonized or other high-risk patients.Screening methods for VRE detection rely on either a culture-based method, generally consisting of an agar medium containing 4 to 8 g of vancomycin and bile esculin (BEAV) to detect bile esculin-positive vancomycin-resistant organisms, or nucleic acid amplification testing (NAAT). Culture-based screening methods using BEAV require 24 to 48 h to identify positive colonies and another 24 to 48 h to confirm identification and vancomycin resistance (5). Several formulations of media have been developed in recent years that reduce the turnaround time for VRE screening. Many of these media contain chromogenic substrates that allow visual confirmation of positive colonies, thereby reducing or eliminating the need for extensive secondary testing (1). NAAT is more rapid, but increased cost and complexity make this type of testing more burdensome than agar plate screening.For this study, 400 remnant deidentified consecutive nonduplicated stool specimens were simultaneously cultured on CHROMagar VanRE (CVRE) and BEAV and evaluated for the presence of VRE after 24 and 48 h of incubation at 35 to 37°C in a 5% CO 2 -enriched atmosphere and ambient air, respectively. Colonies recovered on BEAV were presumptively identified as VRE by the results of testing that included Gram stain morphology analysis, a negative catalase reaction, and PYR (L-pyrrolidonyl-␤-naphthylamide) hydrolysis. Isolates were subcultured for phenotypic identification (VITEK2, bioMérieux, Durham, NC) and vancomycin susceptibility testing by broth microdilution. Similarly, colonies producing a characteristic green or mauve color on CVRE (Fig. 1) were

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Risk Factors for Development of Vancomycin‐Resistant Enterococcal Bloodstream Infection in Patients with Cancer Who Are Colonized with Vancomycin‐Resistant Enterococci

Cited by 130 publications

References 27 publications

Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?

Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?

Acquisition and Duration of Vancomycin-Resistant Enterococcal Carriage in Relation to Strain Type

Evaluation of a Chromogenic Agar under Development To Screen for VRE Colonization

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