Clostridium difficile Infection Is a Risk Factor for Bacteremia Due to Vancomycin‐Resistant Enterococci (VRE) in VRE‐Colonized Patients with Acute Leukemia

Department of Medicine, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore 21201, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 12/1997; 25(5):1056-9. DOI: 10.1086/516112
Source: PubMed


A cohort study was conducted in a cancer center to identify risk factors for bacteremia with vancomycin-resistant enterococci
(VRE) in neutropenic cancer patients colonized with VRE. There were 10 patients with VRE bacteremia among 56 colonized with
VRE, of whose charts 51 were available for review. One hundred percent of patients with VRE bacteremia (10 of 10) vs. 56%
of patients without VRE bacteremia (23 of 41) had acute leukemia (P = .01, Fisher's exact test). Four of the 10 patients with VRE bacteremia had a positive Clostridium difficile toxin assay within 6 days of their first positive VRE blood culture. Both C. difficile infection and antimicrobial (vancomycin and ciprofloxacin) use during VRE colonization were significant risk factors for
VRE bacteremia in univariate analysis. When a Cox proportional hazards model was used to account for differences in follow-up
time, C. difficile infection was the only statistically significant risk factor (risk ratio, 8.2; P = .007) for VRE bacteremia in VRE-colonized patients with acute leukemia.

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    • "Studies which examined the factors associated with VRE colonisation and/or a range of different VRE infections have either had vanA genotype as the predominant strain (as reported or through personal communication with the authors) [9-14], or did not report the genotype [4,15-29]. All aforementioned studies were performed in the US, where vanA is predominant [2]. "
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    ABSTRACT: Background Enterococci are a major cause of healthcare-associated infection. In Australia, vanB vancomycin-resistant enterococci (VRE) is the predominant genotype. There are limited data on the factors linked to vanB VRE bacteraemia. This study aimed to identify factors associated with vanB VRE bacteraemia, and compare them with those for vancomycin-susceptible enterococci (VSE) bacteraemia. Methods A case-case-control study was performed in two tertiary public hospitals in Victoria, Australia. VRE and VSE bacteraemia cases were compared with controls without evidence of enterococcal bacteraemia, but may have had infections due to other pathogens. Results All VRE isolates had vanB genotype. Factors associated with vanB VRE bacteraemia were urinary catheter use within the last 30 days (OR 2.86, 95% CI 1.09-7.53), an increase in duration of metronidazole therapy (OR 1.65, 95% CI 1.17-2.33), and a higher Chronic Disease Score specific for VRE (OR 1.70, 95% CI 1.05-2.77). Factors linked to VSE bacteraemia were a history of gastrointestinal disease (OR 2.29, 95% CI 1.05-4.99) and an increase in duration of metronidazole therapy (OR 1.23, 95% CI 1.02-1.48). Admission into the haematology/oncology unit was associated with lower odds of VSE bacteraemia (OR 0.08, 95% CI 0.01-0.74). Conclusions This is the largest case-case-control study involving vanB VRE bacteraemia. Factors associated with the development of vanB VRE bacteraemia were different to those of VSE bacteraemia.
    Full-text · Article · Jun 2014 · BMC Infectious Diseases
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    • "However, it could not be the only mechanism because the PFGE analysis demonstrated a high degree of diversity among the isolates, and bacteremia of endogenous origin could not be excluded. As reported earlier, the hemato-oncological disease itself has been recognized as an important risk factor for the acquisition of VRE (12, 28, 29). In addition to the lack of host immunity, breakdown of the gastrointestinal mucosal barrier and subsequent translocation of bowel flora could play a major role in the acquisition of VRE bacteremia (30-32). "
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    ABSTRACT: An increase in vancomycin-resistant enterococcal (VRE) bacteremia in hemato-oncological patients (n=19) in our institution from 2000 through 2001 led us to analyze the molecular epidemiologic patterns and clinical features unique to our cases. The pulsed field gel electrophoresis of the isolates revealed that the bacteremia was not originated from a single clone but rather showed endemic pattern of diverse clones with small clusters. A different DNA pattern of blood and stool isolates from one patient suggested exogenous rather than endogenous route of infection. Enterococcus faecium carrying vanA gene was the causative pathogen in all cases. Patients with VRE bacteremia showed similar clinical courses compared with those with vancomycin-susceptible enterococcal (VSE) bacteremia. Vancomycin resistance did not seem to be a poor prognostic factor because of similar mortality (5/8, 62.5%) noted in VSE bacteremia. Initial disease severity and neutropenic status may be major determinants of prognosis in patients with VRE bacteraemia.
    Full-text · Article · May 2005 · Journal of Korean Medical Science
    • "Many reports have included haemato-oncology patients in their analysis of VRE acquisition. However, only a few have studied strictly haematological populations (Guiot et al, 1991; Chadwick et al, 1996; Roghmann et al, 1997). "
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    ABSTRACT: We describe an outbreak of vancomycin-resistant Enterococcus faecium (VRE) on the haematology ward of a Dutch university hospital. After the occurrence of three consecutive cases of bacteraemia with VRE, strains were genotyped and found to be identical. During the next 4 months an intensive surveillance programme identified 21 additional patients to be colonized with VRE, while two more patients developed bacteraemia. A case–control study was carried out to identify risk factors for VRE acquisition. In comparison with VRE-negative control patients (n=49), cases (n=24) had a longer stay on the ward during the year preceding the outbreak (25·8 versus 10·1 d, P=0·02), more cases with acute myeloid leukaemia [11 versus 4, odds ratio (OR) 9·5, 95% confidence interval (CI95) 2·4–32·2] and higher grades of mucositis (P=0·03). Logistic regression analysis identified antibiotic use within 1 month before admission (OR 13·0, CI95 2·1–80·5, P=0·006) and low albumin levels at baseline (OR 1·2, CI95 1·1–1·3, P=0·02) to be independent risk factors. Four patients with VRE-bacteraemia were successfully treated with quinupristin/dalfopristin (Synercid®). Control of the outbreak was achieved by step-wise implementation of intensive infection control measures, which included the cohorting of patients, allocation of nurses and reinforcement of hand hygiene.
    No preview · Article · Jan 2002 · British Journal of Haematology
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