Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-29T09:49:55.991Z Has data issue: false hasContentIssue false
  • English
  • Français

Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

Published online by Cambridge University Press:  09 November 2016

Hsiu-Yin Chiang ,
Eli N. Perencevich ,
Rajeshwari Nair ,
Richard E. Nelson ,
Matthew Samore ,
Karim Khader ,
Margaret L. Chorazy ,
Loreen A. Herwaldt ,
Amy Blevins  and
Melissa A. Ward
...Show all authors
Hsiu-Yin Chiang
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa
Eli N. Perencevich
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Rajeshwari Nair
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Richard E. Nelson
Affiliation:
Department of Clinical Epidemiology, University of Utah, Salt Lake City, Utah
Matthew Samore
Affiliation:
Department of Clinical Epidemiology, University of Utah, Salt Lake City, Utah
Karim Khader
Affiliation:
Department of Clinical Epidemiology, University of Utah, Salt Lake City, Utah
Margaret L. Chorazy
Affiliation:
University of Iowa College of Public Health, Iowa City, Iowa
Loreen A. Herwaldt
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa University of Iowa College of Public Health, Iowa City, Iowa
Amy Blevins
Affiliation:
Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana
Melissa A. Ward
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa
Marin L. Schweizer*
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa Iowa City Veterans Affairs Health Care System, Iowa City, Iowa University of Iowa College of Public Health, Iowa City, Iowa
*
Address correspondence to Marin L. Schweizer, PhD, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242-1071 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

Information about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics.

OBJECTIVE

To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes.

METHODS

We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data.

RESULTS

Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more).

CONCLUSIONS

VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections.

Infect Control Hosp Epidemiol. 2017;38:203–215

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 2 , February 2017 , pp. 203 - 215
Copyright
© 2016 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.)

References

REFERENCES

1. Cetinkaya, Y, Falk, P, Mayhall, CG. Vancomycin-resistant enterococci. Clin Microbiol Rev 2000;13:687–707.Google Scholar
2. Hidron, AI, Edwards, JR, Patel, J, 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. Infect Control Hosp Epidemiol 2008;29:996–1011.Google Scholar
3. Sievert, DM, Ricks, P, Edward, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol 2013;34:1–14.Google Scholar
4. Salgado, CD, Farr, BM. Outcomes associated with vancomycin-resistant enterococci: a meta-analysis. Infect Control Hosp Epidemiol 2003;24:690–698.Google Scholar
5. Monnet, DL, Frimodt-Møller, N. Only percentage within species; neither incidence, nor prevalence: demographic information and representative surveillance data are urgently needed to estimate the burden of antimicrobial resistance. Int J Antimicrob Agents 2004;24:622–623.Google Scholar
6. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
7. Neidell, MJ, Cohen, B, Furuya, Y, et al. Costs of healthcare- and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms. Clin Infect Dis 2012;55:807–815.CrossRefGoogle ScholarPubMed
8. Kaye, KS, Engemann, JJ, Mazaffari, E, Carmeli, Y. Reference group choice and antibiotic resistance outcomes. Emerg Infect Dis 2004;10:1125–1128.CrossRefGoogle ScholarPubMed
9. Stroup, DF, Berlin, JA, Morton, SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008–2012.Google Scholar
10. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Ann Intern Med 2009;151:264–269.Google Scholar
11. Stang, A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010;25:603–605.Google Scholar
12. Evers, S, Goossens, M, de Vet, H, van Tulder, M, Ament, A. Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria. Int J Technol Assess Health Care 2005;21:240–245.Google Scholar
13. Camins, BC, Farley, MM, Jernigan, JJ, Ray, SM, Steinberg, JP, Blumberg, HM. A population-based investigation of invasive vancomycin-resistant Enterococcus infection in metropolitan Atlanta, Georgia, and predictors of mortality. Infect Control Hosp Epidemiol 2007;28:983–991.Google Scholar
14. Hayakawa, K, Marchaim, D, Vidaillac, C, et al. Growing prevalence of vancomycin-resistant Enterococcus faecalis in the region with the highest prevalence of vancomycin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2011;32:922–924.Google Scholar
15. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.Google Scholar
16. Wang, Y, Eldridge, N, Metersky, ML, et al. National trends in patient safety for four common conditions, 2005-2011. N Engl J Med 2014;370:341–351.CrossRefGoogle ScholarPubMed
17. Hayakawa, K, Marchaim, D, Martin, ET, et al. Comparison of the clinical characteristics and outcomes associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant E. faecium bacteremia. Antimicrob Agents Chemother 2012;56:2452–2458.Google Scholar
18. Hayakawa, K, Marchaim, D, Palla, M, et al. Epidemiology of vancomycin-resistant Enterococcus faecalis: a case-case-control study. Antimicrob Agents Chemother 2013;57:49–55.Google Scholar
19. Omotola, AM, Li, Y, Martin, ET, et al. Risk factors for and epidemiology of community-onset vancomycin-resistant Enterococcus faecalis in southeast Michigan. Am J Infect Control 2013;41:1244–1248.CrossRefGoogle ScholarPubMed
20. Britt, NS, Potter, EM, Patel, N, Steed, ME. Comparison of the effectiveness and safety of linezolid and daptomycin in vancomycin-resistant enterococcal bloodstream infection: a national cohort study of Veterans Affairs patients. Clin Infect Dis 2015;61:871–878.Google Scholar
21. Song, X, Srinivasan, A, Plaut, D, Perl, TM. Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs. Infect Control Hosp Epidemiol 2003;24:251–256.CrossRefGoogle ScholarPubMed
22. Raad, I, Hachem, R, Hanna, H, et al. Prospective, randomized study comparing quinupristin-dalfopristin with linezolid in the treatment of vancomycin-resistant Enterococcus faecium infections. J Antimicrob Chemother 2004;53:646–649.Google Scholar
23. DiazGranados, CA, Jernigan, JA. Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection. J Infect Dis 2005;191:588–595.Google Scholar
24. Gearhart, M, Martin, J, Rudich, S, et al. Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study. Clin Transplant 2005;19:711–716.Google Scholar
25. Butler, AM, Olsen, MA, Merz, LR, et al. Attributable costs of enterococcal bloodstream infections in a nonsurgical hospital cohort. Infect Control Hosp Epidemiol 2010;31:25–35.CrossRefGoogle Scholar
26. Scheetz, MH, Knechtel, SA, Postelnick, MJ, Malczynski, M, Qi, C. Differences in clinical outcomes in patients with vancomycin-resistant enterococci according to linezolid susceptibility. Pharmacother 2010;30:1221–1228.Google Scholar
27. Santayana, EM, Grim, SA, Janda, WM, Layden, JE, Lee, TA, Clark, NM. Risk factors and outcomes associated with vancomycin-resistant Enterococcus infections with reduced susceptibilities to linezolid. Diag Microb . Infect Dis 2012;74:39–42.Google Scholar
28. Vydra, J, Shanley, RM, George, I, et al. Enterococcal bacteremia is associated with increased risk of mortality in recipients of allogeneic hematopoietic stem cell transplantation. Clin Infect Dis 2012;55:764–770.Google Scholar
29. 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.Google Scholar
30. Ramsey, AM, Zilberberg, MD. Secular trends of hospitalization with vancomycin-resistant Enterococcus infection in the United States, 2000-2006. Infect Control Hosp Epidemiol 2009;30:184–186.Google Scholar
31. Reik, R, Tenover, FC, Klein, E, McDonald, LC. The burden of vancomycin-resistant enterococcal infections in US hospitals, 2003 to 2004. Diag Microb Infect Dis 2008;62:81–85.Google Scholar
32. Nguyen, GC, Leung, W, Weizman, AV. Increased risk of vancomycin-resistant Enterococcus infection among patients hospitalized for inflammatory bowel disease in the United States. Inflamm Bowel Dis 2011;17:1338–1342.Google Scholar
33. Zilberberg, MD, Shorr, AF, Kollef, MH. Growth and geographic variation in hospitalizations with resistant infections, United States, 2000-2005. Emerg Infect Dis 2008;14:1756–1758.Google Scholar
34. Zilberberg, MD, Shorr, AF, Kollef, MH. Growth in the incidence of hospitalizations with resistant infections in elderly people in the United States: 2000 to 2006. J Am Geriatr Soc 2008;56:2356–2358.Google Scholar
35. Dubberke, ER, Butler, Am, Nyazee, HA, et al. The impact of ICD-9-CM code rank order on the estimated prevalence of Clostridium difficile infections. Clin Infect Dis 2011;53:20–25.Google Scholar
36. Schweizer, ML, Eber, MR, Laxminarayan, R, et al. Validity of ICD-9-CM coding for identifying incident methicillin-resistant Staphylococcus aureus (MRSA) infections: is MRSA infection coded as a chronic disease? Infect Control Hosp Epidemiol 2011;32:148–154.Google Scholar
37. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC). Investigation and control of vancomycin-resistant Staphylococcus aureus (VRSA): 2015 update. CDC website. http://www.cdc.gov/hai/pdfs/VRSA-Investigation-Guide-05_12_2015.pdf. Updated April 2015. Accessed June 21, 2016.Google Scholar
38. 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.Google Scholar
39. Prematunge, C, MacDougall, C, Johnstone, J, et al. VRE and VSE bacteremia outcomes in the era of effective VRE therapy: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2016;37:26–35.Google Scholar
40. Nelson, RE, Nelson, SD, Khader, K, et al. The magnitude of time-dependent bias in the estimation of excess length of stay attributable to healthcare-associated infections. Infect Control Hosp Epidemiol 2015;36:1089–1094.Google Scholar
Supplementary material: File

Chiang supplementary material

Chiang supplementary material 1

Download Chiang supplementary material(File)
File 31.9 KB