Risk factors for enterococcal infection and colonization by vancomycin-resistant enterococci in critically ill patients

Papadimitriou-Olivgeris, Matthaios; Δρούγκα, Ελεάννα; Fligou, Fotini; Kolonitsiou, Fevronia; Liakopoulos, Apostolos; Dodou, Vasiliki; Anastassiou, E.D.; Petinaki, Efthymia; Marangos, Markos; Filos, Kriton S.; Spiliopoulou, Iris

doi:10.1007/s15010-014-0678-1

Cited by 85 publications

(81 citation statements)

References 20 publications

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“…Vancomycin resistance of nosocomial isolates was more common in Enterococcus faecium carrying the vanA gene, as was also shown by previous studies (Abriouel et al, 2008;Duprè et al, 2003;Papadimitriou-Olivgeris et al, 2014). No enterococcal water isolate was VRE.…”

Section: Discussionsupporting

confidence: 73%

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Biofilm synthesis and presence of virulence factors among enterococci isolated from patients and water samples

Papadimitriou-Olivgeris

Filippidou

Δρούγκα

et al. 2015

Journal of Medical Microbiology

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The goal of this study was to compare biofilm synthesis among enterococci recovered from clinical samples (infection or colonization) of patients as well as environmental samples in order to determine possible virulence factors and clonal relationship. During a two-year period, clinical samples (blood, catheter tips, bronchial secretions, wounds, peritoneal fluid, urine) and rectal swabs collected from hospitalized patients as well as environmental water samples were tested for the presence of Enterococcus faecalis and Enterococcus faecium. Antibiotic susceptibility testing was performed by the disc diffusion method and Etest. Strains were tested for the presence of vanA, vanB, esp, ace and asp genes by PCR. Clones were identified by PFGE (Sma I). From infected patients, 48 strains were identified: 24 Enterococcus faecium (10 vanApositive, 14 vancomycin-susceptible) and 24 Enterococcus faecalis (one vanA-positive, 23 vancomycin-susceptible). Among 143 colonizing isolates, 134 were Enterococcus faecium (58 vanA-positive, 11 vanB-positive, 65 vancomycin-susceptible) and nine Enterococcus faecalis (three vanA-positive, two vanB-positive, four vancomycin-susceptible). Among 167 environmental water samples, 51 Enterococcus faecalis and 19 Enterococcus faecium isolates, all glycopeptide-susceptible, were recovered. In total, 64 strains produced biofilm, whereas 34 were esp-positive, 64 asp-positive and 54 ace-positive. Biofilm production was associated with the presence of esp (P,0.001) and ace genes (P50.021), being higher in infecting (P,0.001) and water (P 0.005) isolates as compared with colonizing ones. Clones of environmental waterstrains were different than the patients' clones. The differences found in the incidence of antibiotic resistance, virulence factors and clones suggest that hospital and water enterococci are of different origin.

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Section: Discussionsupporting

confidence: 73%

“…They constitute an important cause of nosocomial infections, the most common species being Enterococcus faecalis and Enterococcus faecium (Abriouel et al, 2008;Comerlato et al, 2013;Papadimitriou-Olivgeris et al, 2014). Their ability to produce biofilm has been implicated in the induction of infections (Upadhyaya et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Biofilm synthesis and presence of virulence factors among enterococci isolated from patients and water samples

Papadimitriou-Olivgeris

Filippidou

Δρούγκα

et al. 2015

Journal of Medical Microbiology

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“…: 571). The Programme included search for rectal colonization by KPC-Kp and VRE, as well as nasal carriage by MRSA among patients and healthcare personnel [6,7].…”

Section: Methodsmentioning

confidence: 99%

“…The fact that co-carriage of KPC-Kp and VRE among intensive care unit (ICU) patients located in nearby beds is the most important factor for their dissemination and highlights the importance of patient cohorting [6,7]. In order to achieve cohorting, especially in wards such as ICUs where MDR bacteria thrive, an adequate number of nursing staff, as well as isolation abilities, are needed.…”

Section: Introductionmentioning

confidence: 99%

Co-colonization by multidrug-resistant bacteria in two Greek intensive care units

Papadimitriou-Olivgeris

Spiliopoulou

Christofidou

et al. 2015

Eur J Clin Microbiol Infect Dis

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Our goal was to identify the risk factors for co-colonization by KPC-producing Klebsiella pneumoniae (KPC-Kp), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) upon intensive care unit (ICU) admission and during stay. Rectal and nasal samples were taken from each patient upon admission at two Greek ICUs and each week afterwards, and were inoculated onto chromogenic agar. Representative colonies were characterized with standard methods and Vitek-2 technology. The presence of the bla KPC gene (K. pneumoniae isolates), vanA and vanB (Enterococcus faecium and E. faecalis isolates), and mecA (S. aureus isolates) was confirmed by polymerase chain reaction (PCR). Upon ICU admission, among 481 patients, 59 (12%), 63 (13%), and 20 (4%) were colonized by KPC-Kp, VRE, or MRSA, respectively. Simultaneous colonization by KPC-Kp and VRE upon admission (34 patients) was associated with the number of co-morbidities [adjusted odds ratio (aOR): 1.5; confidence interval (CI) 1.0-2.5], administered antibiotics (aOR: 1.7; CI 1.3-2.3), and prior KPC-Kp infection (aOR: 24.4; CI 1.5-396.0). Among patients with an ICU stay of more than 6 days, 181 (73%), 31 (13%), and 9 (4%) became KPC-Kp, VRE, or MRSA colonized during ICU stay, respectively. KPC-Kp colonization was an independent risk factor for VRE colonization upon admission (aOR: 2.7; CI 1.0-7.2) and during stay (aOR: 7.4; CI 2.0-27.4), whereas VRE colonization was a risk factor for KPC-Kp upon admission (aOR: 5.1; CI 1.9-13.9) and MRSA colonization upon admission (aOR: 3.5; CI 1.2-10.1) and during ICU stay (aOR: 14.5; CI 2.1-100.1). Colonization by a multidrug pathogen could promote colonization by another.

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“…또한 의료관련(healthcare-associated) 요로 감염의 위험이 높 고 [9,10] 내성 균주에 의한 요로 감염 위험도 증가시키므로 [11][12][13][14] 주의를 요한다. 본 글에서는 당뇨병 환자의 요로 감 염에 대해 살펴보고자 한다.…”

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Urinary Tract Infection in Diabetes

Kim

2017

J Korean Diabetes

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Urinary tract infection (UTI) is common in patients with diabetes mellitus. Furthermore, UTI is more severe, more often caused by resistant pathogens, and produces worse outcomes in those with diabetes mellitus. Although some patients may have altered clinical signs, symptoms of UTI are similar in patients with or without diabetes mellitus. Treatment depends on severity of systemic symptoms, results of urine culture, and underlying diseases of patients. There are no definite indications to treat asymptomatic bacteriuria in patients with diabetes mellitus.

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Risk factors for enterococcal infection and colonization by vancomycin-resistant enterococci in critically ill patients

Cited by 85 publications

References 20 publications

Biofilm synthesis and presence of virulence factors among enterococci isolated from patients and water samples

Biofilm synthesis and presence of virulence factors among enterococci isolated from patients and water samples

Co-colonization by multidrug-resistant bacteria in two Greek intensive care units

Urinary Tract Infection in Diabetes

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