TY - JOUR
T1 - Vancomycin resistance has no influence on outcomes of enterococcal bacteriuria
AU - Khair, H. N.
AU - VanTassell, P.
AU - Henderson, J. P.
AU - Warren, D. K.
AU - Marschall, J.
N1 - Funding Information:
J.M. was supported by the NIH CTSA/NCATS ( UL1RR024992 ) and recipient of a KL2 Career Development Grant ( KL2RR024994 ); he is currently supported by the NIH Office of Research for Women's Health with a BIRCWH award (Building Interdisciplinary Research Careers in Women's Health; grant # 5K12HD001459-13 ). He is also the section leader for a subproject of the CDC Prevention Epicenters Program grant (U54 CK000162; P.I. Fraser). In addition, J.M. receives support from the Barnes–Jewish Hospital Patient Safety & Quality Fellowship Program, which is funded by The Foundation for Barnes–Jewish Hospital . He also received a research grant from the Barnes–Jewish Hospital Foundation & Washington University's Institute of Clinical and Translational Sciences (ICTS) . J.P.H. is the recipient of a Burroughs–Wellcome Career Award for Medical Scientists and is supported by the National Institutes of Health ( HD001459-09 and DK064540-09 ). D.K.W. received a CDC Prevention Epicenters Program grant ( U54 CK000162 ; P.I. Fraser).
Funding Information:
D.W. is a Consultant for 3M Healthcare and Cardinal Health, and has received research funding from Sage Products, Inc., and Cubist Pharmaceuticals. All other authors have no conflicts of interest to declare.
PY - 2013/11
Y1 - 2013/11
N2 - 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.
AB - 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.
KW - Asymptomatic disease
KW - Enterococcus
KW - Outcomes research
KW - Urinary tract infection
KW - Vancomycin
UR - http://www.scopus.com/inward/record.url?scp=84885844116&partnerID=8YFLogxK
U2 - 10.1016/j.jhin.2013.07.007
DO - 10.1016/j.jhin.2013.07.007
M3 - Article
C2 - 23998947
AN - SCOPUS:84885844116
SN - 0195-6701
VL - 85
SP - 183
EP - 188
JO - Journal of Hospital Infection
JF - Journal of Hospital Infection
IS - 3
ER -