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Patient-level analysis of incident vancomycin-resistant enterococci colonization and antibiotic days of therapy

  • J. A. McKINNELL (a1) (a2) (a3), D. F. KUNZ (a4), S. A. MOSER (a5), S. VANGALA (a6), C.-H. TSENG (a6), M. SHAPIRO (a7) and L. G. MILLER (a1) (a2)...
Summary

Vancomycin-resistant enterococci (VRE) infections are a public health threat associated with increased patient mortality and healthcare costs. Antibiotic usage, particularly cephalosporins, has been associated with VRE colonization and VRE bloodstream infections (VRE BSI). We examined the relationship between antimicrobial usage and incident VRE colonization at the individual patient level. Prospective, weekly surveillance was undertaken for incident VRE colonization defined by negative admission but positive surveillance swab in a medical intensive care unit over a 17-month period. Antimicrobial exposure was quantified as days of therapy (DOT)/1000 patient-days. Multiple logistic regression was used to analyse incident VRE colonization and antibiotic DOT, controlling for demographic and clinical covariates. Ninety-six percent (1398/1454) of admissions were swabbed within 24 h of intensive care unit (ICU) arrival and of the 380 patients in the ICU long enough for weekly surveillance, 83 (22%) developed incident VRE colonization. Incident colonization was associated in bivariate analysis with male gender, more previous hospital admissions, longer previous hospital stay, and use of cefepime/ceftazidime, fluconazole, azithromycin, and metronidazole (P < 0·05). After controlling for demographic and clinical covariates, metronidazole was the only antibiotic independently associated with incident VRE colonization (odds ratio 2·0, 95% confidence interval 1·2–3·3, P < 0·009). Our findings suggest that risk of incident VRE colonization differs between individual antibiotic agents and support the possibility that antimicrobial stewardship may impact VRE colonization and infection.

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Corresponding author
*Author for correspondence: J. A. McKinnell, MD, Infectious Disease Clinical Outcomes Research Unit, Harbor-UCLA Division of Infectious Disease, David Geffen School of Medicine, 1124 West Carson Street, Box 466, Torrance, CA 90502, USA. (Email: Dr.McKinnell@yahoo.com)
References
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1. Centers for Disease Control and Prevention. Vital signs: carbapenem-resistant Enterobacteriaceae. Morbidity and Mortality Weekly Report 2013; 62: 165170.
2. Siegel, JD, et al. Management of multidrug-resistant organisms in health care settings, 2006. American Journal of Infection Control 2007; 35 (Suppl. 2): S165193.
3. 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.
4. 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: 9961011.
5. Wisplinghoff, H, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clinical Infectious Diseases 2004; 39: 309317.
6. 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.
7. System NNIS. 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.
8. Quale, J, et al. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clinical Infectious Diseases 1996; 23: 10201025.
9. Bradley, SJ, et al. The control of hyperendemic glycopeptide-resistant Enterococcus spp. on a haematology unit by changing antibiotic usage. Journal of Antimicrobial Chemotherapy 1999; 43: 261266.
10. Montecalvo, MA, et al. Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Annals of Internal Medicine 1999; 131: 269272.
11. Smith, DW. Decreased antimicrobial resistance after changes in antibiotic use. Pharmacotherapy 1999; 19: 129S132S; discussion 33S–37S.
12. Manzella, J, et al. Choice of antibiotic and risk of colonization with vancomycin-resistant Enterococcus among patients admitted for treatment of community-acquired pneumonia. Infection Control and Hospital Epidemiology 2000; 21: 789791.
13. May, AK, et al. Reduction of vancomycin-resistant enterococcal infections by limitation of broad-spectrum cephalosporin use in a trauma and burn intensive care unit. Shock 2000; 14: 259264.
14. Nourse, C, et al. Eradication of vancomycin resistant Enterococcus faecium from a paediatric oncology unit and prevalence of colonization in hospitalized and community-based children. Epidemiology and Infection 2000; 124: 5359.
15. Puzniak, LA, et al. Acquisition of vancomycin-resistant enterococci during scheduled antimicrobial rotation in an intensive care unit. Clinical Infectious Diseases 2001; 33: 151157.
16. Lautenbach, E, et al. Changes in the prevalence of vancomycin-resistant enterococci in response to antimicrobial formulary interventions: impact of progressive restrictions on use of vancomycin and third-generation cephalosporins. Clinical Infectious Diseases 2003; 36: 440446.
17. Stiefel, U, et al. Effect of the increasing use of piperacillin/tazobactam on the incidence of vancomycin-resistant enterococci in four academic medical centers. Infection Control and Hospital Epidemiology 2004; 25: 380383.
18. Paterson, DL, et al. Acquisition of rectal colonization by vancomycin-resistant Enterococcus among intensive care unit patients treated with piperacillin-tazobactam versus those receiving cefepime-containing antibiotic regimens. Antimicrobial Agents and Chemotherapy 2008; 52: 465469.
19. Donskey, CJ, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. New England Journal of Medicine 2000; 343: 19251932.
20. Donskey, CJ, et al. Recurrence of vancomycin-resistant Enterococcus stool colonization during antibiotic therapy. Infection Ccontrol and Hospital Epidemiology 2002; 23: 436440.
21. Donskey, CJ, et al. Effect of parenteral antibiotic administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. Journal of Infectious Diseases 1999; 180: 384390.
22. Lakticova, V, et al. Antibiotic-induced enterococcal expansion in the mouse intestine occurs throughout the small bowel and correlates poorly with suppression of competing flora. Antimicrobial Agents and Chemotherapy 2006; 50: 31173123.
23. Rice, LB, et al. Beta-lactam antibiotics and gastrointestinal colonization with vancomycin-resistant enterococci. Journal of Infectious Diseases 2004; 189: 11131118.
24. Taur, Y, et al. Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clinical Infectious Diseases 2012; 55: 905–14.
25. Bonten, MJ, et al. The role of ‘colonization pressure’ in the spread of vancomycin-resistant enterococci: an important infection control variable. Archives of Internal Medicine 1998; 158: 11271132.
26. McKinnell, JA, et al. Association between vancomycin-resistant enterococci bacteremia and ceftriaxone usage. Infection Control and Hospital Epidemiology 2012; 33: 718724.
27. Weinstein, JW, et al. Comparison of rectal and perirectal swabs for detection of colonization with vancomycin-resistant enterococci. Journal of Clinical Microbiology 1996; 34: 210212.
28. Donskey, CJ, et al. Effect of parenteral antibiotic administration on the establishment of colonization with vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. Journal of Infectious Diseases 2000; 181: 18301833.
29. Bhalla, A, et al. Antianaerobic antibiotic therapy promotes overgrowth of antibiotic-resistant, gram-negative bacilli and vancomycin-resistant enterococci in the stool of colonized patients. Infection Control and Hospital Epidemiology 2003; 24: 644649.
30. Kinnebrew, MA, et al. Bacterial flagellin stimulates Toll-like receptor 5-dependent defense against vancomycin-resistant Enterococcus infection. Journal of Infectious Diseases 2010; 201: 534543.
31. Poutanen, SM, Simor, AE. Clostridium difficile-associated diarrhea in adults. Canadian Medical Association Journal 2004; 171: 5158.
32. Kyne, L, et al. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet 2001; 357: 189193.
33. California Department of Public Health. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) bloodstream infections (BSI) in California hospitals, 2011 (http://www.cdph.ca.gov/programs/hai/Pages/MRSAandVRE-Report.aspx).
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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