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Vancomycin‐resistant Enterococcus faecium infection in patients with hematologic malignancy: patients with acute myeloid leukemia are at high‐risk
Author(s) -
Worth Leon J.,
Thursky Karin A.,
Seymour John F.,
Slavin Monica A.
Publication year - 2007
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2007.00911.x
Subject(s) - medicine , neutropenia , febrile neutropenia , bacteremia , vancomycin , enterococcus faecium , myeloid leukemia , fungemia , population , intensive care medicine , antibiotics , immunology , chemotherapy , staphylococcus aureus , microbiology and biotechnology , mycosis , genetics , environmental health , bacteria , biology
Background: Vancomycin‐resistant enterococci (VRE) are significant nosocomial pathogens in patients with hematologic malignancy. Identification of risk factors for infection is necessary for targeted prevention and surveillance. Objectives and methods: An outbreak of VRE infection occurred at a tertiary cancer hospital between 1 August 2003 and 30 June 2005. Infection control measures recommended by the Society for Healthcare Epidemiology of America were used throughout the outbreak period. A matched case–control study was performed to identify risk factors for VRE infection. Results: Fourteen VRE infections (13 episodes of bacteremia, one urinary tract infection) occurred a median of 10.5 d following hospital admission. All were due to Enterococcus faecium vanB . Univariate analysis identified the following variables to be significantly associated with VRE infection: presence of neutropenia, neutropenia ≥7 d, underlying diagnosis of acute myeloid leukemia (AML), and receipt of vancomycin, metronidazole or carbapenem antibiotic therapy in the 30 d prior to infection. On multivariate analysis, an underlying diagnosis of AML [odds ratio (OR), 15.00; P = 0.017] and vancomycin therapy during the previous 30 d (OR, 17.96; P = 0.036) were retained as independent risk factors for infection. Conclusions: Risk stratification for development of VRE infection is possible for patients with hematologic malignancy. Patients with AML represent a high‐risk population, and targeted prevention strategies must include improved antibiotic stewardship, particularly judicious use of vancomycin therapy.