Contemporary Clinical and Molecular Epidemiology of Vancomycin-Resistant Enterococcal Bacteremia: A Prospective Multicenter Cohort Study (VENOUS I)
Journal
Open Forum Infectious Diseases
ISSN
2328-8957
Date Issued
2021
Author(s)
German A Contreras
Shelby Simar
Courtney Luterbach
An Q Dinh
Kirsten Rydell
Pranoti V Sahasrabhojane
Rafael Rios
Lorena Diaz
Katherine Reyes
Marcus Zervos
Helina M Misikir
Gabriela Sanchez-Petitto
Catherine Liu
Yohei Doi
Lilian M Abbo
Luis Shimose
Harald Seifert
Carlota Gudiol
Fernanda Barberis
Claudia Pedroza
Samuel L Aitken
Samuel A Shelburne
David van Duin
Truc T Tran
Blake M Hanson
Cesar A Arias
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Vancomycin-resistant enterococci (VRE) are major therapeutic challenges. Prospective contemporary data characterizing the clinical and molecular epidemiology of VRE bloodstream infections (BSIs) are lacking.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>The Vancomycin-Resistant Enterococcal BSI Outcomes Study (VENOUS I) is a prospective observational cohort of adult patients with enterococcal BSI in 11 US hospitals. We included patients with Enterococcus faecalis or Enterococcus faecium BSI with ≥1 follow-up blood culture(s) within 7 days and availability of isolate(s) for further characterization. The primary study outcome was in-hospital mortality. Secondary outcomes were mortality at days 4, 7, 10, 12, and 15 after index blood culture. A desirability of outcome ranking was constructed to assess the association of vancomycin resistance with outcomes. All index isolates were subjected to whole genome sequencing.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>Forty-two of 232 (18%) patients died in hospital and 39 (17%) exhibited microbiological failure (lack of clearance in the first 4 days). Neutropenia (hazard ratio [HR], 3.13), microbiological failure (HR, 2.4), VRE BSI (HR, 2.13), use of urinary catheter (HR, 1.85), and Pitt BSI score ≥2 (HR, 1.83) were significant predictors of in-hospital mortality. Microbiological failure was the strongest predictor of in-hospital mortality in patients with E faecium bacteremia (HR, 5.03). The impact of vancomycin resistance on mortality in our cohort changed throughout the course of hospitalization. Enterococcus faecalis sequence type 6 was a predominant multidrug-resistant lineage, whereas a heterogeneous genomic population of E faecium was identified.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Failure of early eradication of VRE from the bloodstream is a major factor associated with poor outcomes.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Vancomycin-resistant enterococci (VRE) are major therapeutic challenges. Prospective contemporary data characterizing the clinical and molecular epidemiology of VRE bloodstream infections (BSIs) are lacking.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>The Vancomycin-Resistant Enterococcal BSI Outcomes Study (VENOUS I) is a prospective observational cohort of adult patients with enterococcal BSI in 11 US hospitals. We included patients with Enterococcus faecalis or Enterococcus faecium BSI with ≥1 follow-up blood culture(s) within 7 days and availability of isolate(s) for further characterization. The primary study outcome was in-hospital mortality. Secondary outcomes were mortality at days 4, 7, 10, 12, and 15 after index blood culture. A desirability of outcome ranking was constructed to assess the association of vancomycin resistance with outcomes. All index isolates were subjected to whole genome sequencing.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>Forty-two of 232 (18%) patients died in hospital and 39 (17%) exhibited microbiological failure (lack of clearance in the first 4 days). Neutropenia (hazard ratio [HR], 3.13), microbiological failure (HR, 2.4), VRE BSI (HR, 2.13), use of urinary catheter (HR, 1.85), and Pitt BSI score ≥2 (HR, 1.83) were significant predictors of in-hospital mortality. Microbiological failure was the strongest predictor of in-hospital mortality in patients with E faecium bacteremia (HR, 5.03). The impact of vancomycin resistance on mortality in our cohort changed throughout the course of hospitalization. Enterococcus faecalis sequence type 6 was a predominant multidrug-resistant lineage, whereas a heterogeneous genomic population of E faecium was identified.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Failure of early eradication of VRE from the bloodstream is a major factor associated with poor outcomes.</jats:p>
</jats:sec>
Cite this document
Contreras, G. A., Munita, J. M., Simar, S., Luterbach, C., Dinh, A. Q., Rydell, K., Sahasrabhojane, P. V., Rios, R., Diaz, L., Reyes, K., Zervos, M., Misikir, H. M., Sanchez-Petitto, G., Liu, C., Doi, Y., Abbo, L. M., Shimose, L., Seifert, H., Gudiol, C., … Arias, C. A. (2022). Contemporary clinical and molecular epidemiology of vancomycin-resistant enterococcal bacteremia: A prospective multicenter cohort study(Venous i). Open Forum Infectious Diseases, 9(3), ofab616. https://doi.org/10.1093/ofid/ofab616
Subjects
bacteremia
;
enterococcus
;
vre
;
amoxicillin plus clavulanic acid
;
beta lactam
;
daptomycin
;
genomic dna
;
ocrelizumab
;
piperacillin plus tazobactam
;
steroid
;
sultamicillin
;
adult
;
aged
;
antibiotic sensitivity
;
article
;
artificial ventilation
;
bioinformatics
;
blood culture
;
bone marrow transplantation
;
chemotherapy
;
cohort analysis
;
comorbidity
;
dna extraction
;
dna sequence
;
enterococcus faecalis
;
enterococcus faecium
;
female
;
follow up
;
hematologic malignancy
;
hospital mortality
;
hospitalization
;
human
;
intensive care unit
;
major clinical study
;
male
;
molecular biology
;
monotherapy
;
multicenter study
;
multidrug resistance
;
neutropenia
;
physician
;
sequence analysis
;
vancomycin resistant enterococcus
;
whole genome sequencing