G Ghanem1, R Hachem, Y Jiang, R F Chemaly, I Raad. 1. Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Abstract
OBJECTIVE: Vancomycin-resistant enterococci (VRE) are a major cause of nosocomial infection. We sought to compare vancomycin-resistant (VR) Enterococcus faecalis bacteremia and VR Enterococcus faecium bacteremia in cancer patients with respect to risk factors, clinical presentation, microbiological characteristics, antimicrobial therapy, and outcomes. METHODS: We identified 210 cancer patients with VRE bacteremia who had been treated between January 1996 and December 2004; 16 of these 210 had VR E. faecalis bacteremia and were matched with 32 patients with VR E. faecium bacteremia and 32 control patients. A retrospective review of medical records was conducted. RESULTS: Logistic regression analysis showed that, compared with VR E. faecalis bacteremia, VR E. faecium bacteremia was associated with a worse clinical response to therapy (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.07-0.98]; P=.046) and a higher overall mortality rate (OR, 8.3 [95% CI, 1.9-35.3]; P=.004), but the VRE-related mortality rate did not show a statistically significant difference (OR, 6.8 [95% CI, 0.7-61.8]; P=.09). Compared with control patients, patients with VR E. faecalis bacteremia were more likely to have received an aminoglycoside in the 30 days before the onset of bacteremia (OR, 5.8 [95% CI, 1.2-27.6]; P=.03), whereas patients with VR E. faecium bacteremia were more likely to have received a carbapenem in the 30 days before the onset of bacteremia (OR, 11.7 [95% CI, 3.6-38.6]; P<.001). In a multivariate model that compared patients with VR E. faecium bacteremia and control patients, predictors of mortality included acute renal failure on presentation (OR, 15.1 [95% CI, 2.3-99.2]; P=.004) and VR E. faecium bacteremia (OR, 11 [95% CI, 2.7-45.1]; P<.001). No difference in outcomes was found between patients with VR E. faecalis bacteremia and control patients. CONCLUSIONS: VR E. faecium bacteremia in cancer patients was associated with a poorer outcome than was VR E. faecalis bacteremia. Recent receipt of carbapenem therapy was an independent risk factor for VR E. faecium bacteremia, and recent receipt of aminoglycoside therapy was independent risk factor for E. faecalis bacteremia.
OBJECTIVE:Vancomycin-resistant enterococci (VRE) are a major cause of nosocomial infection. We sought to compare vancomycin-resistant (VR) Enterococcus faecalisbacteremia and VR Enterococcus faeciumbacteremia in cancerpatients with respect to risk factors, clinical presentation, microbiological characteristics, antimicrobial therapy, and outcomes. METHODS: We identified 210 cancerpatients with VRE bacteremia who had been treated between January 1996 and December 2004; 16 of these 210 had VR E. faecalisbacteremia and were matched with 32 patients with VR E. faeciumbacteremia and 32 control patients. A retrospective review of medical records was conducted. RESULTS: Logistic regression analysis showed that, compared with VR E. faecalisbacteremia, VR E. faeciumbacteremia was associated with a worse clinical response to therapy (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.07-0.98]; P=.046) and a higher overall mortality rate (OR, 8.3 [95% CI, 1.9-35.3]; P=.004), but the VRE-related mortality rate did not show a statistically significant difference (OR, 6.8 [95% CI, 0.7-61.8]; P=.09). Compared with control patients, patients with VR E. faecalisbacteremia were more likely to have received an aminoglycoside in the 30 days before the onset of bacteremia (OR, 5.8 [95% CI, 1.2-27.6]; P=.03), whereas patients with VR E. faeciumbacteremia were more likely to have received a carbapenem in the 30 days before the onset of bacteremia (OR, 11.7 [95% CI, 3.6-38.6]; P<.001). In a multivariate model that compared patients with VR E. faeciumbacteremia and control patients, predictors of mortality included acute renal failure on presentation (OR, 15.1 [95% CI, 2.3-99.2]; P=.004) and VR E. faeciumbacteremia (OR, 11 [95% CI, 2.7-45.1]; P<.001). No difference in outcomes was found between patients with VR E. faecalisbacteremia and control patients. CONCLUSIONS: VR E. faeciumbacteremia in cancerpatients was associated with a poorer outcome than was VR E. faecalisbacteremia. Recent receipt of carbapenem therapy was an independent risk factor for VR E. faeciumbacteremia, and recent receipt of aminoglycoside therapy was independent risk factor for E. faecalisbacteremia.
Authors: Max Desole; Karin G Schrenk; Ulf Schnetzke; Andreas Hochhaus; Sebastian Scholl Journal: J Cancer Res Clin Oncol Date: 2015-11-30 Impact factor: 4.553
Authors: Manjiree V Karandikar; Carly E Milliren; Robin Zaboulian; Poornima Peiris; Tanvi Sharma; Andrew E Place; Thomas J Sandora Journal: J Pediatric Infect Dis Soc Date: 2020-09-17 Impact factor: 3.164
Authors: M Tavadze; L Rybicki; S Mossad; R Avery; M Yurch; B Pohlman; H Duong; R Dean; B Hill; S Andresen; R Hanna; N Majhail; E Copelan; B Bolwell; M Kalaycio; R Sobecks Journal: Bone Marrow Transplant Date: 2014-08-11 Impact factor: 5.483
Authors: Graeme N Forrest; Mary-Claire Roghmann; Latoya S Toombs; Jennifer K Johnson; Elizabeth Weekes; Durry P Lincalis; Richard A Venezia Journal: Antimicrob Agents Chemother Date: 2008-07-28 Impact factor: 5.191
Authors: Stefan Geiss-Liebisch; Suzan H M Rooijakkers; Agnieszka Beczala; Patricia Sanchez-Carballo; Karolina Kruszynska; Christian Repp; Tuerkan Sakinc; Evgeny Vinogradov; Otto Holst; Johannes Huebner; Christian Theilacker Journal: J Biol Chem Date: 2012-08-20 Impact factor: 5.157
Authors: M P Freire; L C Pierrotti; H H C Filho; K Y Ibrahim; A S G K Magri; P R Bonazzi; L Hajar; M P E Diz; J Pereira; P M Hoff; E Abdala Journal: Eur J Clin Microbiol Infect Dis Date: 2014-08-30 Impact factor: 3.267