title: Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci.
abstract: Vancomycin-resistant Enterococcus faecium (VRE) is a common nosocomial isolate, especially among patients with cancer. VRE infections have substantial attributable mortality among patients with cancer. The purpose of this study was to identify risk factors for developing bloodstream infection with VRE in patients with cancer who are colonized with VRE. VRE colonization was prospectively identified in 197 patients with cancer during 4-year period, of whom 179 (91%) had complete records for evaluation. Of these 179 patients, 24 (13.4%) developed hospital-acquired VRE bloodstream infections. Risk factors for VRE bloodstream infection included vancomycin use (relative risk [RR], 1.98; 95% confidence interval [CI], 1.25-3.14), diabetes mellitus (RR, 3.91; 95% CI, 1.20-12.77), gastrointestinal procedures (RR, 4.56; 95% CI, 1.05-19.7), and acute renal failure (RR, 3.10; 95% CI, 1.07-8.93). Strategies for preventing VRE bloodstream infection in VRE-colonized patients with cancer should include limiting vancomycin use and, perhaps, gastrointestinal procedures.
authors.affiliation: Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21205, USA. azaas1@jhmi.edu
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Zaas
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Song
authors.forename: Pamela
authors.initials: P
authors.lastname: Tucker
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D016984:Enterococcus faecium; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology; D012307:Risk Factors; D020713:Vancomycin Resistance / Q000502:physiology*