Experience with the Roche LightCycler VRE detection kit during a large outbreak of vanB2/B3 vancomycin-resistant Enterococcus faecium

Abstract

impairment developed in half of the patients. A switch to second-line antimycotics was also performed at the same percentage in both patient cohorts, either due to persisting fever or due to side effects. Mean duration of AmB therapy was slightly longer with 24 h infusions than with 6 h infusions (median 10.5 versus 7 days on AmB), because renal impairment on average developed slightly more slowly in the 24 h infusion cohort, but this trend was not significant (P 1⁄4 0.44, Mann–Whitney test). The 4 week survival rate was not significantly different (P 1⁄4 0.43, Fisher’s exact test). Overall, no difference in outcome was observed. Taken together, at least in our hands, continuous infusion of AmB turned out to be feasible. It had the advantage of being well tolerated regarding acute side effects without the need for pre-medication except electrolyte solutions, and the number of days on AmB therapy was slightly increased when compared with 6 h infusions. However, continuous infusions did not eliminate the nephrotoxicity that is frequently induced by this drug and did not change the outcome in our cohort. The problem of nephrotoxicity can be avoided by alternative preparations of amphotericin B than AmB deoxycholate or by newer antifungals, but at considerably higher drug expenses.