Increase in bloodstream infection due to vancomycin-susceptible Enterococcus faecium in cancer patients: risk factors, molecular epidemiology and outcomes.
We conducted a prospective study to assess the risk factors, molecular epidemiology and outcome of bloodstream infection (BSI) due to Enterococcus faecium in hospitalized cancer patients. Between 2006 and 2012, a significant increase in vancomycin-susceptible E. faecium BSI was observed among cancer patients. Comparison of 54 episodes of BSI due to E. faecium with 38 episodes of BSI due to E. faecalis showed that previous use of carbapenems was the only independent risk factor for E. faecium acquisition (OR 10.24; 95% CI, 1.35-77.66). All E. faecium isolates were susceptible to glycopeptides, whereas 97% showed high-level resistance to ampicillin and ciprofloxacin. All 30 isolates available for genotyping belonged to the hospital-associated E. faecium lineages 17, 18 and 78. After 2009, most of the isolates belonged to ST117 (lineage 78). Patients with E. faecium BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with E. faecalis BSI, and time to adequate empirical antibiotic therapy was also longer in the former group. No significant differences were found between the two groups regarding early and overall case-fatality rates. Independent risk factors for overall case-fatality were current corticosteroids (OR 4.18; 95% CI, 1.34-13.01) and intensive care unit admission (OR 9.97; 95% CI, 1.96-50.63). The emergence of E. faecium among cancer patients is a concern since there are limited treatment options and it may presage the emergence of vancomycin-resistant enterococci. A rationale approach that combines infection control with antimicrobial stewardship.
Department of Infectious Disease, Hospital Universitari de Bellvitge, Barcelona, Insitut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain ; REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain.
Carlota
C
Gudiol
Josefina
J
Ayats
Mariana
M
Camoez
M Ángeles
MÁ
Domínguez
Carolina
C
García-Vidal
Marta
M
Bodro
Carmen
C
Ardanuy
Mora
M
Obed
Montserrat
M
Arnan
Maite
M
Antonio
Jordi
J
Carratalà
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia; D016984:Enterococcus faecium / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D009369:Neoplasms / Q000150:complications*; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology*; D055815:Young Adult
D014640:Vancomycin