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Incidence of vancomycin-resistant enterococci (VRE) infection in high-risk febrile neutropenic patients colonized with VRE

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Abstract

Purpose

This study seeks to determine the incidence of vancomycin-resistant enterococci (VRE) infection in high-risk neutropenic fever patients colonized with VRE and to determine patient characteristics associated with VRE infection.

Methods

We conducted a retrospective, single-center, unmatched case-control study. Fifty-three VRE-colonized, high-risk patients with neutropenic fever were identified between January 2006 and February 2009. The two most common diagnoses/conditions included acute myeloid leukemia and hematopoietic stem cell transplantation. Data collected included days of neutropenia, days of fever, demographic data, culture results, and antimicrobial therapy.

Results

Twenty of the 53 patients (38%) with VRE colonization developed a VRE infection. The most common VRE infections were bacteremias (26%). The presence of neutropenia lasting longer than 7 days was associated with the development of VRE infection in this high-risk population colonized with VRE. The timeframe to develop VRE infection varied from 1 day to 2 weeks.

Conclusion

For patients colonized with VRE, approximately 38% of high-risk neutropenic patients developed a VRE infection. This is the first study to specifically evaluate the incidence of VRE infections in febrile neutropenic patients colonized with VRE. Future research into the use and efficacy of empiric VRE coverage is needed.

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Abbreviations

FN:

febrile neutropenia

VRE:

vancomycin-resistant enterococci

HSCT:

hematopoietic stem cell transplantation

BSI:

blood stream infection

ANC:

absolute neutrophil count

References

  1. Hughes WT, Armstrong D, Bodey GP et al (2002) Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  PubMed  Google Scholar 

  2. National Comprehensive Cancer Network. 2008 Prevention and treatment of cancer-related infections. [http://www.nccn.org/professionals/physician_gls/PDF/infections.pdf] Accessed 12/11/08

  3. Bhavnani SM, Drake JA, Forrest A et al (2000) A nationwide, multicenter, case-control study comparing risk factors, treatment and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis 36:145–158

    Article  PubMed  CAS  Google Scholar 

  4. Vergis EN, Hayden MK, Chow JW et al (2001) Determination of vancomycin resistance and mortality rates in enterococcal bacteremia: a prospective multicenter study. Ann Intern Med 135:484–492

    PubMed  CAS  Google Scholar 

  5. DiazGranados CA, Jernigan JA (2005) Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection. Jour Infect Dis 191:588–595

    Article  CAS  Google Scholar 

  6. Olivier CN, Blake RK, Steed LL et al (2008) Risk of vancomycin-resistant enterococcus (VRE) bloodstream infection among patients colonized with VRE. Infect Control Hosp Epidemiol 29:404–409

    Article  PubMed  Google Scholar 

  7. Zaas AK, Song X, Tucker P et al (2002) Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci. Clin Infect Dis 35:1139–1146

    Article  PubMed  Google Scholar 

  8. Matar MJ, Tarrand J, Raad I et al (2006) Colonization and infection with vancomycin-resistant enterococcus among patients with cancer. Am Jour Infect Control 34:534–536

    Article  Google Scholar 

  9. Weinstock DM, Conlon M, Iovino C et al (2007) Colonization, bloodstream infection, and mortality caused by vancomycin-resistant enterococcus early after allogeneic hematopoietic stem cell transplant. Biol Blood Marrow Transplant 13:615–621

    Article  PubMed  Google Scholar 

  10. Pertel PE, Bernado P, Fogarty C et al (2008) Effects of prior effective therapy on the efficacy of daptomycin and ceftriaxone for the treatment of community-acquired pneumonia. Clin Infect Dis 46:1142–1151

    Article  PubMed  CAS  Google Scholar 

  11. Gerson SL, Kaplan SL, Bruss JB et al (2002) Hematolog effects of linezolid: summary of clinical experience. Antimicrob Agents Chemother 46:2723–2726

    Article  PubMed  CAS  Google Scholar 

  12. Poutsiaka DD, Skiffington S, Miller KB et al (2007) Daptomycin in the treatment of vancomycin-resistant Enterococcus faecium bacteremia in neutropenic patients. Jour Infect 54:567–571

    Article  Google Scholar 

  13. Smith PF, Birmingham MC, Noskin GA et al (2003) Safety, efficacy, and pharmacokinetics of linezolid for treatment of resistant Gram-positive infections in cancer patients with neutropenia. Ann Oncol 14:795–801

    Article  PubMed  CAS  Google Scholar 

  14. Jaksic B, Martinelli G, Perez-Oteyza J et al (2006) Efficacy and safety of linezolid compared to vancomycin in a randomized, double-blind study of febrile neutropenic patients with cancer. Clin Infect Dis 42:597–607

    Article  PubMed  CAS  Google Scholar 

  15. Poutsiaka DD, Skiffington S, Miller KB et al (2007) Daptomycin in the treatment of vancomycin-resistant Enterococcus faecium bacteremia in neutropenic patients. Jour of Infect 54:567–571

    Article  Google Scholar 

  16. Eys A, Rapoport BL, Anderson R (2004) Febrile neutropenia: a prospective study to validate the Multinational Associatation of Supportive Care of Cancer (MASCC) risk-index score. Support Care Cancer 12:555–560

    Google Scholar 

  17. Dubberke ER, Hollands JM, Georgantopoulos P et al (2006) Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker? Bone Marrow Transplant 38:813–819

    Article  PubMed  CAS  Google Scholar 

  18. Rostein C, Mandell LA, Goldberg N (1997) Fluoroquinolone prophylaxis for profoundly neutropenic cancer patients: a meta-analysis. Curr Opin Oncol 4(Suppl 2):S2–S7

    Google Scholar 

  19. Cruciani M, Rampazzo R, Malena M et al (1996) Prophylaxis with fluoroquinolones in neutropenic patients: a meta-analysis. Clin Infect Dis 23:795–805

    Article  PubMed  CAS  Google Scholar 

  20. Carratala J, Fernandez-Sevilla A, Tubau F et al (1995) Emergence of quinolone-resistant Escherichia coli bacteremia in neutropenic patients with cancer who received prophylactic norfloxacin. Clin Infect Dis 20:557–560

    Article  PubMed  CAS  Google Scholar 

  21. Kern WV, Andriof E, Oethinger M et al (1994) Emergence of fluoroquinolone-resistant Escherichia coli at a cancer center. Antimicrob Agents Chemother 38:681–687

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA

    John B. Bossaer

  2. Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA

    Philip D. Hall

  3. Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA

    Elizabeth Garrett-Mayer

  4. South Carolina College of Pharmacy, 274 Calhoun Street, MSC 141, Charleston, SC, 29425, USA

    Philip D. Hall

Authors
  1. John B. Bossaer
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  2. Philip D. Hall
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Correspondence to Philip D. Hall.

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Bossaer, J.B., Hall, P.D. & Garrett-Mayer, E. Incidence of vancomycin-resistant enterococci (VRE) infection in high-risk febrile neutropenic patients colonized with VRE. Support Care Cancer 19, 231–237 (2011). https://doi.org/10.1007/s00520-009-0808-y

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