1735. Bloodstream Infection Due to Vancomycin Susceptible vs Vancomycin Resistant Enterococcus faecium in Patients with Hematologic Malignancies. Case-Control Study
Session: Poster Abstract Session: Treatment of Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • E faecium BSI Alatorre Mexico.pdf (2.0 MB)
  • Background: Enterococcus faecium(EF) has emerged as an important pathogen in patients with hematologic malignancies (HM), as a cause of nosocomial bloodstream infection (BSI). The first BSI due to Vancomycin resistant EF (EFVR) at the Instituto Nacional de Cancerología (INCan) occurred in 2008 in a patient with Acute Lymphoblastic Leukemia repatriated from USA. An outbreak of VREF BSI started in 2010 that peaked in 2011 and decreased after preventive strategies were applied. The objective is to assess the clinical features and outcome of patients with vancomycin susceptible EF (VSEF) and VREF BSI; and to identify  resistance patterns in VREF strains.

    Methods: We performed a retrospective case control study of patients with HM and positive blood culture for EF taken from January 2008 to December 2012. Cases were considered patients with VREF isolated from blood cultures and controls were patients with isolation of VSEF. We collected data on the clinical characteristics and outcome of the patients included. Pulsed-field gel electrophoresis was used to identify resistance genes in strains of VREF.

    Results: Fifty-eight episodes of EF BSI occurred; 37 VSEF and 21 VREF. Half were women, the average age 36.9 years (15-78). 4 patients had 2 events of BSI, 2 of them initially VSEF and later VREF. 21 patients had positive sequential cultures, 14 of them in the case group(p=0.01). 12 patients received prophylactic antibiotic associated to IDA-FLAG chemotherapy. Factors related with VSEF BSI were a previous episode of BSI three months before the actual event (p = 0.039) and early stage of the underlying disease on admission (p = 0.044). Factors associated with VREF BSI were prophylactic antibiotic treatment (p = 0.013) and vancomycin therapy in the previous 3 months (p = 0.001). There was no relationship between the grade and length of neutropenia, admission to ICU and outcome at 30 days and one year. Attributable mortality due to EF BSI was 25% (15/58) overall, 39% in the case group and 17.% in the control group (p=0.061). Molecular analysis identified that all resistant strains were vanA Enterococcus faecium.

    Conclusion: VREF BSI in patients with HM is associated to high mortality. History of prophylactic antibiotics and vancomycin use was associated to VREF BSI. Antimicrobial stewardship is imperative for prevention.

    Pamela Alatorre Fernández, MD, Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico, Claudia Mayoral Teran, MD, Departamento De Microbiologia y Parasitologia, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico, Alejandro Schcolnick Cabrera, MD, Departamento De Microbiología y Parasitología, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico, Yolanda López Vidal, MD, Departamento De Microbiología y Parasitología, Universidad Nacional Autonoma de Mexico, Mexico, Mexico and Patricia Volkow, MD, Infectious Diseases Department, Instituto Nacional de Cancerologia, Mexico City, Mexico


    P. Alatorre Fernández, None

    C. Mayoral Teran, None

    A. Schcolnick Cabrera, None

    Y. López Vidal, None

    P. Volkow, None

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