title: Vancomycin-resistant enterococci with reduced daptomycin susceptibility in Singapore: prevalence and associated factors.
abstract: Prevalence of vancomycin-resistant enterococci (VRE) and use of daptomycin are increasing in Asia. To determine the prevalence of daptomycin non-susceptible enterococci (DNSE) and understand factors associated with reduced daptomycin susceptibility in VRE, we conducted a case-control study in a 1600-bed adult tertiary hospital in Singapore. All VRE isolates from inpatients in 2012 were tested for daptomycin susceptibility. Patients with VRE isolates of daptomycin minimum inhibitory concentration (MIC) ⩾3 µg/ml were classified as daptomycin-reduced susceptible VRE (DRS-VRE) and those with daptomycin MIC 4 µg/ml (DNSE). About half (135, 55%) had reduced susceptibility to daptomycin (MIC 3-4 µg/ml). None in the DS-VRE group had prior exposure to daptomycin. After adjusting for age, gender, comorbidity, hospitalization duration, surgical history, indwelling device use, and duration of antibiotic exposure in the prior 3 months, >1 movement between wards [odds ratio (OR) 0·35, 95% confidence interval (CI) 0·16-0·74, P = 0·006] and minocycline resistance (OR 0·45, 95% CI 0·25-0·84, P = 0·011) were independently associated with DRS-VRE. Our study suggests that daptomycin exposure, >1 movement between wards, and resistance to minocycline, were associated with reduced daptomycin susceptibility in VRE.
authors.affiliation: Department of Clinical Epidemiology,Institute of Infectious Diseases and Epidemiology,Tan Tock Seng Hospital,Singapore.
authors.forename: A
authors.initials: A
authors.lastname: Chow
authors.affiliation: Department of Clinical Epidemiology,Institute of Infectious Diseases and Epidemiology,Tan Tock Seng Hospital,Singapore.
authors.forename: N N
authors.initials: NN
authors.lastname: Win
authors.affiliation: Department of Clinical Epidemiology,Institute of Infectious Diseases and Epidemiology,Tan Tock Seng Hospital,Singapore.
authors.forename: P Y
authors.initials: PY
authors.lastname: Ng
authors.affiliation: Department of Laboratory Medicine,Tan Tock Seng Hospital,Singapore.
authors.forename: W
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Clinical Epidemiology,Institute of Infectious Diseases and Epidemiology,Tan Tock Seng Hospital,Singapore.
authors.forename: M K
authors.initials: MK
authors.lastname: Win
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D017576:Daptomycin / Q000494:pharmacology*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D012846:Singapore / Q000453:epidemiology; D062606:Tertiary Care Centers; D020713:Vancomycin Resistance; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects* / Q000502:physiology*
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin
keywords: DNSE; VRE; epidemiology; reduced daptomycin susceptibility; risk factors