Vancomycin resistance has no influence on outcomes of enterococcal bacteriuria⋆
Published Date:Aug 30 2013
Source:J Hosp Infect. 2013; 85(3):183-188.
Corporate Authors:for the CDC Prevention Epicenters Program
Aged, 80 And Over
Gram-Positive Bacterial Infections
Urinary Tract Infection
Pubmed Central ID:PMC4109057
Funding:5K12HD001459-13/HD/NICHD NIH HHS/United States
DK064540-09/DK/NIDDK NIH HHS/United States
HD001459-09/HD/NICHD NIH HHS/United States
K12 HD001459/HD/NICHD NIH HHS/United States
K12 RR023249/RR/NCRR NIH HHS/United States
KL2RR024994/RR/NCRR NIH HHS/United States
P50 DK064540/DK/NIDDK NIH HHS/United States
U54 CK000162/CK/NCEZID CDC HHS/United States
UL1RR024992/RR/NCRR NIH HHS/United States
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.
To describe the epidemiology of enterococcal bacteriuria in a hospital and compare the clinical picture and patient outcomes depending on vancomycin resistance.
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.
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.
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.
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