Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-12-01T01:55:59.988Z Has data issue: false hasContentIssue false
  • English
  • Français

A retrospective cohort study of antibiotic exposure and vancomycin-resistant Enterococcus recolonization

Published online by Cambridge University Press:  07 February 2019

Heather Y. Hughes Open the ORCID record for Heather Y. Hughes [Opens in a new window] ,
Robin T. Odom ,
Angela V. Michelin ,
Evan S. Snitkin ,
Ninet Sinaii ,
Aaron M. Milstone ,
David K. Henderson  and
Tara N. Palmore
Heather Y. Hughes
Affiliation:
The Ralph H. Johnson VAMC, Charleston, South Carolina The Medical University of South Carolina, Charleston, South Carolina
Robin T. Odom
Affiliation:
National Institutes of Health, Bethesda, Maryland
Angela V. Michelin
Affiliation:
National Institutes of Health, Bethesda, Maryland
Evan S. Snitkin
Affiliation:
University of Michigan Medical School, Ann Arbor, Michigan
Ninet Sinaii
Affiliation:
National Institutes of Health, Bethesda, Maryland
Aaron M. Milstone
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
David K. Henderson
Affiliation:
National Institutes of Health, Bethesda, Maryland
Tara N. Palmore*
Affiliation:
National Institutes of Health, Bethesda, Maryland
*
Author for correspondence: Tara N. Palmore, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

In the National Institutes of Health (NIH) Clinical Center, patients colonized or infected with vancomycin-resistant Enterococcus (VRE) are placed in contact isolation until they are deemed “decolonized,” defined as having 3 consecutive perirectal swabs negative for VRE. Some decolonized patients later develop recurrent growth of VRE from surveillance or clinical cultures (ie, “recolonized”), although that finding may represent recrudescence or new acquisition of VRE. We describe the dynamics of VRE colonization and infection and their relationship to receipt of antibiotics.

Methods:

In this retrospective cohort study of patients at the National Institutes of Health Clinical Center, baseline characteristics were collected via chart review. Antibiotic exposure and hospital days were calculated as proportions of VRE decolonized days. Using survival analysis, we assessed the relationship between antibiotic exposure and time to VRE recolonization in a subcohort analysis of 72 decolonized patients.

Results:

In total, 350 patients were either colonized or infected with VRE. Among polymerase chain reaction (PCR)-positive, culture (Cx)-negative (PCR+/Cx−) patients, PCR had a 39% positive predictive value for colonization. Colonization with VRE was significantly associated with VRE infection. Among 72 patients who met decolonization criteria, 21 (29%) subsequently became recolonized. VRE recolonization was 4.3 (P = .001) and 2.0 (P = .22) times higher in patients with proportions of antibiotic days and antianaerobic antibiotic days above the median, respectively.

Conclusion:

Colonization is associated with clinical VRE infection and increased mortality. Despite negative perirectal cultures, re-exposure to antibiotics increases the risk of VRE recolonization.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 4 , April 2019 , pp. 414 - 419
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: Part of these data were presented as an abstract at ID Week 2014 on October 9, 2014, in Philadelphia, Pennsylvania, and as a poster presentation at ID Week 2015 on October 9, 2015, in San Diego, California.

References

Cattoir, V, Leclercq, R. Twenty-five years of shared life with vancomycin-resistant enterococci: Is it time to divorce? J Antimicrob Chemother 2013;68:731–742.CrossRefGoogle ScholarPubMed
Arias, CA, Mendes, RE, Stilwell, MG, Jones, RN, Murray, BE. Unmet needs and prospects for oritavancin in the management of vancomycin-resistant enterococcal infections. Clin Infect Dis 2012;54 Suppl 3:S233–S238.10.1093/cid/cir924CrossRefGoogle ScholarPubMed
DiazGranados, CA, Zimmer, SM, Klein, M, Jernigan, JA. Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 2005;41:327–333.CrossRefGoogle ScholarPubMed
Arias, CA, Panesso, D, McGrath, DM, et al. Genetic basis for in vivo daptomycin resistance in enterococci. N Engl J Med 2011;365:892–900.CrossRefGoogle ScholarPubMed
Diaz, L, Kiratisin, P, Mendes, RE, Panesso, D, Singh, KV, Arias, CA. Transferable plasmid-mediated resistance to linezolid due to cfr in a human clinical isolate of Enterococcus faecalis. Antimicrob Agents Chemother 2012;56:3917–3922.CrossRefGoogle Scholar
Murray, BE. Vancomycin-resistant enterococcal infections. N Engl J Med 2000;342:710–721.CrossRefGoogle ScholarPubMed
Calderwood, MS, Mauer, A, Tolentino, J, Flores, E, van Besien, K, Pursell, K, Weber, SG. Epidemiology of vancomycin-resistant enterococci among patients on an adult stem cell transplant unit: observations from an active surveillance program. Infect Control Hosp Epidemiol 2008;29:1019–1025.CrossRefGoogle ScholarPubMed
Almyroudis, NG, Lesse, AJ, Hahn, T, et al. Molecular epidemiology and risk factors for colonization by vancomycin-resistant Enterococcus in patients with hematologic malignancies. Infect Control Hosp Epidemiol 2011;32:490–496.CrossRefGoogle ScholarPubMed
Ford, CD, Lopansri, BK, Haydoura, S, et al. Frequency, risk factors, and outcomes of vancomycin-resistant Enterococcus colonization and infection in patients with newly diagnosed acute leukemia: different patterns in patients with acute myelogenous and acute lymphoblastic leukemia. Infect Control Hosp Epidemiol 2015;36:47–53.10.1017/ice.2014.3CrossRefGoogle ScholarPubMed
Weinstock, DM, Conlon, M, Iovino, C, et al. Colonization, bloodstream infection, and mortality caused by vancomycin-resistant Enterococcus early after allogeneic hematopoietic stem cell transplant. Biol Blood Marrow Transplant 2007;13:615–621.10.1016/j.bbmt.2007.01.078CrossRefGoogle ScholarPubMed
Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35:S165–S193.CrossRefGoogle ScholarPubMed
Banach, DB, Bearman, G, Barnden, M, et al. Duration of contact precautions for acute-care settings. Infect Control Hosp Epidemiol 2018;39:127–144.CrossRefGoogle ScholarPubMed
Bhalla, A, Pultz, NJ, Ray, AJ, Hoyen, CK, Eckstein, EC, Donskey, CJ. Antianaerobic antibiotic therapy promotes overgrowth of antibiotic-resistant, gram-negative bacilli and vancomycin-resistant enterococci in the stool of colonized patients. Infect Control Hosp Epidemiol 2003;24:644–649.CrossRefGoogle ScholarPubMed
Donskey, CJ, Hoyen, CK, Das, SM, Helfand, MS, Hecker, MT. Recurrence of vancomycin-resistant Enterococcus stool colonization during antibiotic therapy. Infect Control Hosp Epidemiol 2002;23:436–440.CrossRefGoogle ScholarPubMed
Lee, WG, Park, IJ, Jin, HY, Park, MH. Relapse and reacquisition of rectal colonization by vancomycin-resistant Enterococcus faecium after decolonization. Epidemiol Infect 2010;138:1449–1453.CrossRefGoogle ScholarPubMed
Kamboj, M, Chung, D, Seo, SK, Pamer, EG, Sepkowitz, KA, Jakubowski, AA, Papanicolaou, G. The changing epidemiology of vancomycin-resistant Enterococcus (VRE) bacteremia in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Biol Blood Marrow Transplant 2010;16:1576–1581.CrossRefGoogle ScholarPubMed
Ford, CD, Gazdik, MA, Lopansri, BK, et al. Vancomycin-resistant enterococcus colonization and bacteremia and hematopoietic stem cell transplantation outcomes. Biol Blood Marrow Transpl 2017;23:340–346.CrossRefGoogle ScholarPubMed
Hefazi, M, Damlaj, M, Alkhateeb, HB, et al. Vancomycin-resistant Enterococcus colonization and bloodstream infection: prevalence, risk factors, and the impact on early outcomes after allogeneic hematopoietic cell transplantatoin in patients with acute myeloid leukemia. Transpl Infect Dis 2016;18:913–920.CrossRefGoogle ScholarPubMed
Donskey, CJ, Chowdhry, TK, Hecker, MT, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med 2000;343:1925–1932.CrossRefGoogle ScholarPubMed
Baden, LR, Thiemke, W, Skolnik, A, et al. Prolonged colonization with vancomycin-resistant Enterococcus faecium in long-term care patients and the significance of “clearance.” Clin Infect Dis 2001;33:1654–1660.CrossRefGoogle ScholarPubMed
Henard, S, Lozniewski, A, Aissa, N, Jouzeau, N, Rabaud, C. Evaluation of the duration of vanA vancomycin-resistant Enterococcus faecium carriage and clearance during a large-scale outbreak in a region of eastern France. Am J Infect Control 2011;39:169–171.CrossRefGoogle Scholar
Stiefel, U, Pultz, NJ, Helfand, MS, Donskey, CJ. Increased susceptibility to vancomycin-resistant Enterococcus intestinal colonization persists after completion of antianaerobic antibiotic treatment in mice. Infect Control Hosp Epidemiol 2004;25:373–379.CrossRefGoogle Scholar
Ubeda, C, Taur, Y, Jenq, RR, et al. Vancomycin-resistant Enterococcus domination of intestinal microbiota is enabled by antibiotic treatment in mice and precedes bloodstream invasion in humans. J Clin Invest 2010;120:4332–4341.CrossRefGoogle ScholarPubMed
Raven, KE, Gouliouris, T, Broderick, H, et al. Complex routes of nosocomial vancomycin-resistant Enterococcus faecium transmission revealed by genome sequencing. Clin Infect Dis 2017;64:886–892.CrossRefGoogle ScholarPubMed