Vancomycin resistance has no influence on outcomes of enterococcal bacteriuria

Khair, H.N.; VanTassell, P.; Henderson, J.P.; Warren, D.K.; Marschall, Jonas (2013). Vancomycin resistance has no influence on outcomes of enterococcal bacteriuria. Journal of hospital infection, 85(3), pp. 183-188. Elsevier 10.1016/j.jhin.2013.07.007

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Background Infections with vancomycin-resistant enterococci (VRE) are a growing concern in hospitals. The impact of vancomycin resistance in enterococcal urinary tract infection is not well-defined. Aim To describe the epidemiology of enterococcal bacteriuria in a hospital and compare the clinical picture and patient outcomes depending on vancomycin resistance. Methods This was a 6-month prospective cohort study of hospital patients who were admitted with or who developed enterococcal bacteriuria in a 1250-bed tertiary care hospital. We examined clinical presentation, diagnostic work-up, management, and outcomes. Findings We included 254 patients with enterococcal bacteriuria; 160 (63%) were female and median age was 65 years (range: 17–96). A total of 116 (46%) bacteriurias were hospital-acquired and 145 (57%) catheter-associated. Most patients presented with asymptomatic bacteriuria (ASB) (119; 47%) or pyelonephritis (64; 25%); 51 (20%) had unclassifiable bacteriuria and 20 (8%) had cystitis. Secondary bloodstream infection was detected in 8 (3%) patients. Seventy of 119 (59%) with ASB received antibiotics (mostly vancomycin). There were 74 (29%) VRE bacteriurias. VRE and vancomycin-susceptible enterococci (VSE) produced similar rates of pyelonephritis [19 (25%) vs 45 (25%); P = 0.2], cystitis, and ASB. Outcomes such as ICU transfer [10 (14%) VRE vs 17 (9%) VSE; P = 0.3], hospital length of stay (6.8 vs 5.0 days; P = 0.08), and mortality [10 (14%) vs 13 (7%); P = 0.1] did not vary with vancomycin susceptibility. Conclusions Vancomycin resistance did not affect the clinical presentation nor did it impact patient outcomes in this cohort of inpatients with enterococcal bacteriuria. Almost half of our cohort had enterococcal ASB; more than 50% of these asymptomatic patients received unnecessary antibiotics. Antimicrobial stewardship efforts should address overtreatment of enterococcal bacteriurias.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Marschall, Jonas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0195-6701

Publisher:

Elsevier

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

21 Mar 2014 11:05

Last Modified:

19 Oct 2015 11:14

Publisher DOI:

10.1016/j.jhin.2013.07.007

Uncontrolled Keywords:

Asymptomatic disease, Enterococcus, Outcomes research, Urinary tract infection, Vancomycin

BORIS DOI:

10.7892/boris.44001

URI:

https://boris.unibe.ch/id/eprint/44001

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