Vancomycin resistance has no influence on outcomes of enterococcal bacteriuria⋆

Details

• Alternative Title:
  J Hosp Infect
• Personal Author:
  Khair, H.N. ; VanTassell, P. ; Henderson, J.P. ; Warren, D.K. ; Marschall, J.
• Corporate Authors:
  for the CDC Prevention Epicenters Program
• Description:
  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.
• Subjects:
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteriuria
  • Cohort Studies
  • Community-Acquired Infections
  • Cross Infection
  • Enterococcus
  • Female
  More +
• Keywords:
  • Asymptomatic disease
  • Enterococcus
  • Outcomes research
  • Urinary tract infection
  • Vancomycin
• Source:
  J Hosp Infect. 2013; 85(3):183-188
• Pubmed ID:
  23998947
• Pubmed Central ID:
  PMC4109057
• Document Type:
  Journal Article
• Funding:
  K12 RR023249/RR/NCRR NIH HHSUnited States/ ; P50 DK064540/DK/NIDDK NIH HHSUnited States/ ; K12 HD001459/HD/NICHD NIH HHSUnited States/ ; DK064540-09/DK/NIDDK NIH HHSUnited States/ ; KL2RR024994/RR/NCRR NIH HHSUnited States/ ; U54 CK000162/CK/NCEZID CDC HHSUnited States/ ; WT_/Wellcome TrustUnited Kingdom/ ; KL2 RR024994/RR/NCRR NIH HHSUnited States/ ; 5K12HD001459-13/HD/NICHD NIH HHSUnited States/ ; HD001459-09/HD/NICHD NIH HHSUnited States/ ; UL1RR024992/RR/NCRR NIH HHSUnited States/ ; UL1 RR024992/RR/NCRR NIH HHSUnited States/
  More +
• Volume:
  85
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/30045/cdc_30045_DS1.pdf
• File Type:
  [PDF - 400.64 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:dfcc195f5ec76f19aeb3330a7c2f9161b3295bd0b4ef7d855ef79e31d51e81ef