Skip to main content Accessibility help
×
Home

Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents

  • J. A. McKINNELL (a1) (a2), M. PATEL (a3) (a4), R. M. SHIRLEY (a3), D. F. KUNZ (a5), S. A. MOSER (a6) and J. W. BADDLEY (a3) (a4)...

Summary

Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSI) are a growing problem with few clinical trials to guide therapy. We conducted a retrospective study of management and predictors of mortality for VRE-BSI at a tertiary-care centre from January 2005 to August 2008. Univariate and multivariable analyses examined the relationship of patient characteristics and antibiotic therapy with 30-day all-cause mortality. Rates of VRE-BSI increased from 0·06 to 0·17 infections/1000 patient-days (P=0·03). For 235 patients, 30-day mortality was 34·9%. Patients were primarily treated with linezolid (44·2%) or daptomycin (36·5%). Factors associated with mortality were haemodialysis [odds ratio (OR) 3·2, 95% confidence interval (CI) 1·6–6·3, P=0·007], mechanical ventilation (OR 3·7, 95% CI 1·3–10·4, P=0·01), and malnutrition (OR 2·0, 95% CI 1·0–4·0, P=0·046). Use of linezolid, but not daptomycin (P=0·052) showed a trend towards an association with survival. In conclusion, VRE-BSI is a growing problem, associated with significant 30-day mortality. Multiple factors were associated with poor outcomes at our hospital.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: J. A. McKinnell, M.D., Los Angeles Biomedical Research Institute, Division of Infectious Diseases, 1124 West Carson Street, Torrance, CA 90502, USA. (Email: Dr.McKinnell@yahoo.com)

References

Hide All
1.Hidron, AI, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infection Control and Hospital Epidemiology 2008; 29: 996–1011.
2.Deshpande, LM, et al. Antimicrobial resistance and molecular epidemiology of vancomycin-resistant enterococci from North America and Europe: a report from the SENTRY antimicrobial surveillance program. Diagnostic Microbiology and Infectious Diseases 2007; 58: 163170.
3.NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. American Journal of Infection Control 2004; 32: 470485.
4.Vergis, EN, et al. Determinants of vancomycin resistance and mortality rates in enterococcal bacteremia: a prospective multicenter study. Annals of Internal Medicine 2001; 135: 484492.
5.Erlandson, KM, et al. Impact of the more-potent antibiotics quinupristin-dalfopristin and linezolid on outcome measure of patients with vancomycin-resistant Enterococcus bacteremia. Clinical Infectious Diseases 2008; 46: 3036.
6.DiazGranados, CA, Jernigan, JA. Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection. Journal of Infectious Diseases 2005; 191: 588595.
7.Gearhart, M, et al. Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study. Clinical Transplantation 2005; 19: 711716.
8.Garbutt, JM, et al. Association between resistance to vancomycin and death in cases of Enterococcus faecium bacteremia. Clinical Infectious Diseases 2000; 30: 466472.
9.Song, JH, et al. Clinical implications of vancomycin-resistant Enterococcus faecium (VRE) with VanD phenotype and vanA genotype. Journal of Antimicrobial Chemotherapy 2008; 61: 838844.
10.Song, X, et al. Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs. Infection Control and Hospital Epidemiology 2003; 24: 251256.
11.Papanicolaou, GA, et al. Nosocomial infections with vancomycin-resistant Enterococcus faecium in liver transplant recipients: risk factors for acquisition and mortality. Clinical Infectious Diseases 1996; 23: 760766.
12.DiazGranados, CA, et al. Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clinical Infectious Diseases 2005; 41: 327333.
13.Warren, RE. Daptomycin in endocarditis and bacteraemia: a British perspective. Journal of Antimicrobial Chemotherapy 2008; 62 (Suppl. 3): 2533.
14.Schwartz, BS, Ngo, PD, Guglielmo, BJ. Daptomycin treatment failure for vancomycin-resistant Enterococcus faecium infective endocarditis: impact of protein binding? Annals of Pharmacotherapy 2008; 42: 289290.
15.Mohr, JF, et al. Daptomycin for the treatment of enterococcal bacteraemia: results from the Cubicin Outcomes Registry and Experience (CORE). International Journal of Antimicrobial Agents 2009; 33: 543548.
16.Mave, V, et al. Vancomycin-resistant enterococcal bacteraemia: is daptomycin as effective as linezolid? Journal of Antimicrobial Chemotherapy 2009; 64: 175180.
17.Camins, BC, et al. A population-based investigation of invasive vancomycin-resistant Enterococcus infection in metropolitan Atlanta, Georgia, and predictors of mortality. Infection Control and Hospital Epidemiology 2007; 28: 983991.
18.Bhavnani, SM, et al. A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagnostic Microbiology and Infectious Diseases 2000; 36: 145158.
19.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control 2008; 36: 309332.
20.Charlson, ME, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 1987; 40: 373383.
21.Boucher, HW, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clinical Infectious Diseases 2009; 48: 112.
22.Reik, R, et al. The burden of vancomycin-resistant enterococcal infections in US hospitals, 2003 to 2004. Diagnostic Microbiology and Infectious Diseases 2008; 62: 8185.
23.Ghanem, G, et al. Outcomes for and risk factors associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant Enterococcus faecium bacteremia in cancer patients. Infection Control and Hospital Epidemiology 2007; 28: 10541059.
24.Poutsiaka, DD, et al. Daptomycin in the treatment of vancomycin-resistant Enterococcus faecium bacteremia in neutropenic patients. Journal of Infection 2007; 54: 567571.
25.Segreti, JA, Crank, CW, Finney, MS. Daptomycin for the treatment of gram-positive bacteremia and infective endocarditis: a retrospective case series of 31 patients. Pharmacotherapy 2006; 26: 347–332.
26.Raad, II, et al. Vancomycin-resistant Enterococcus faecium: catheter colonization, esp gene, and decreased susceptibility to antibiotics in biofilm. Antimicrobial Agents and Chemotherapy 2005; 49: 50465050.
27.Moellering, RC, et al. The efficacy and safety of quinupristin/dalfopristin for the treatment of infections caused by vancomycin-resistant Enterococcus faecium. Synercid Emergency-Use Study Group. Journal of Antimicrobial Chemotherapy 1999; 44: 251261.
28.Kvirikadze, N, et al. Daptomycin for the treatment of vancomycin resistant Enterococcus faecium bacteremia. Scandinavian Journal of Infectious Diseases 2006; 38: 290292.
29.Cunha, BA, Mickail, N, Eisenstein, L. E. faecalis vancomycin-sensitive enterococcal bacteremia unresponsive to a vancomycin tolerant strain successfully treated with high-dose daptomycin. Heart and Lung 2007; 36: 456461.
30.Levine, DP. Clinical experience with daptomycin: bacteraemia and endocarditis. Journal of Antimicrobial Chemotherapy 2008; 62 (Suppl. 3): 3539.
31.Chien, JW, Kucia, ML, Salata, RA. Use of linezolid, an oxazolidinone, in the treatment of multidrug-resistant gram-positive bacterial infections. Clinical Infectious Diseases 2000; 30: 146151.
32.Fowler, VG Jr., et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clinical Infectious Diseases 1998; 27: 478486.
33.Patel, M, et al. Initial management of candidemia at an academic medical center: evaluation of the IDSA guidelines. Diagnostic Microbiology and Infectious Diseases 2005; 52: 2934.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed