title: Risk factors and clinical outcomes for vancomycin-resistant enterococcus bacteraemia in hospitalised cancer patients in Pakistan: A case-control study.
abstract: OBJECTIVE
  To compare the risk factors and outcomes of vancomycin-resistant enterococcus with vancomycin-sensitive enterococcus bacteraemia among hospitalised cancer patients.
  
  
  METHODS
  The retrospective, case-control study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of cancer patients whose blood culture grew either vancomycin-sensitive or vancomycin-resistant enterococcus from January 2012 to December 2014. Multivariable logistic regression analyses were used to determine the factors associated with the development of vancomycin-resistant enterococcus bacteraemia and 12-week mortality. Stata 11 was used for data analysis.
  
  
  RESULTS
  Of the 138 cases, 111(80%) were selected, of which 46(41.44%) were of vancomycin-resistant and 65(58.55%) were of vancomycin-sensitive enterococcus. Length of hospital stay prior to bacteraemia (adjusted odds ratio 1.18; 95% confidence interval 1.08-1.28) and use of vancomycin 30 days before the onset of bacteraemia (adjusted odds ratio 9.4; 95% confidence interval 1.70-52.19) were significant risk factors for the development of vancomycin-resistant enterococcus bacteraemia. The overall 12-week mortality rate was 29(63%) for patients with vancomycin-resistant bacteraemia and 28(43.1%) for vancomycin-sensitive enterococcus bacteraemia patients. Risk factors for mortality included the presence of shock at the time of the onset of bacteraemia (adjusted odds ratio 32.91; 95% confidence interval 3.02-358.81).
  
  
  CONCLUSIONS
  The length of hospital stay and prior exposure to vancomycin were significant risk factors for the occurrence of vancomycin-resistant enterococcus bacteraemia.
authors.affiliation: Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan.
authors.forename: Nasim
authors.initials: N
authors.lastname: Akhtar
authors.affiliation: Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan.
authors.forename: Faisal
authors.initials: F
authors.lastname: Sultan
authors.affiliation: Department of Pathology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan.
authors.forename: Summiya
authors.initials: S
authors.lastname: Nizamuddin
authors.affiliation: Clinical Research Scientist, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan.
authors.forename: Waleed
authors.initials: W
authors.lastname: Zafar
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D016022:Case-Control Studies; D002648:Child; D003627:Data Interpretation, Statistical; D016983:Enterococcus / Q000187:drug effects / Q000472:pathogenicity; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality; D010154:Pakistan / Q000453:epidemiology; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Enterococci, Vancomycin-resistant, Vancomycin-sensitive, Bacteraemia.