title: Catheter-related vancomycin-resistant Enterococcus faecium bacteremia: clinical and molecular epidemiology.
abstract: OBJECTIVE
  To study the clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium organisms causing catheter-related bacteremia in patients with cancer.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas.
  
  
  METHODS
  Case-patients were patients with cancer who had catheter-related vancomycin-resistant E. faecium bacteremia and control-patients were patients with cancer and vancomycin-resistant E. faecium gastrointestinal colonization without infection.
  
  
  RESULTS
  Ten case-patients with catheter-related vancomycin-resistant E. faecium bacteremia were compared with 30 control-patients with gastrointestinal colonization by vancomycin-resistant E. faecium. Patients with catheter-related vancomycin-resistant E. faecium bacteremia were more likely to have required mechanical ventilation (P < .01), received total parenteral nutrition (P < .01), and had polyurethane catheters (P < .01) inserted in the femoral vein (P = .01). With the use of pulsed-field gel electrophoresis, 4 of the 10 catheter-related vancomycin-resistant E. faecium bacteremia isolates were genetically indistinguishable, whereas only 2 of the 30 control vancomycin-resistant E. faecium isolates displayed this same DNA pattern (P = .03).
  
  
  CONCLUSIONS
  This study suggests that catheter-related vancomycin-resistant E. faecium bacteremia occurs more frequently in patients who receive total parenteral nutrition, mechanical ventilation, and femoral catheters.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. iraad@mdanderson.org
authors.forename: Issam I
authors.initials: II
authors.lastname: Raad
authors.forename: Hend A
authors.initials: HA
authors.lastname: Hanna
authors.forename: Maha
authors.initials: M
authors.lastname: Boktour
authors.forename: Noel
authors.initials: N
authors.lastname: Jabbour
authors.forename: Ray Y
authors.initials: RY
authors.lastname: Hachem
authors.forename: Rabih O
authors.initials: RO
authors.lastname: Darouiche
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology*; D015373:Bacterial Typing Techniques / Q000379:methods; D016022:Case-Control Studies; D002404:Catheterization / Q000009:adverse effects*; D015897:Comorbidity; D004269:DNA, Bacterial / Q000235:genetics; D016984:Enterococcus faecium / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D020713:Vancomycin Resistance
chemical_list: D004269:DNA, Bacterial