Faecium Bacteremia Research Articles

Clinical characteristics and treatment outcomes of vancomycin-resistant Enterococcus faecium bacteremia.

Vancomycin-resistant Enterococcus faecium (VRE-fm) bacteremia causes significant mortality in hospitalized patients. We sought to investigate clinical characteristics, treatment outcomes, and microbiological eradication associated with VRE-fm bacteremia. A retrospective cohort study was conducted and included 210 adult patients admitted between January 1, 2011 and December 31, 2015. The mean Pitt bacteremia score was 4.7. ICU stay (48.6%) and mechanical ventilation (46.2%) were common. Diabetes mellitus was the most common concomitant disease (43.3%), followed by malignancies, including hematologic malignancies (14.3%) and solid cancers (28.1%). The 14-day and 28-day mortality rates were 37.1% and 50.5%, respectively. Linezolid or daptomycin treatment for at least 10 days and higher Pitt bacteremia scores were independently associated with 14-day and 28-day mortality. Longer treatment duration of linezolid or daptomycin predicted microbiological eradication independently. Daptomycin-treated patients tended to have higher 14-day and 28-day mortality, and lower microbial eradication rates (20.8% versus 8.7%; 40.6% versus 26.1%; 14.1% versus 26.1%; respectively) than linezolid-treated patients, and cumulative survival rates at 14 and 28 days tended to be lower in patients who received low-dose daptomycin (<10mg/kg/day) than that in those who received linezolid and high-dose daptomycin (≥10mg/kg/day); however, the differences were not statistically significant. Higher disease severity and inappropriate treatment were associated with increased mortality and longer treatment duration of linezolid or daptomycin was associated with microbial eradication for the patient with VRE-fm bacteremia.

Effect of Continuous and Sequential Therapy among Veterans Receiving Daptomycin or Linezolid for Vancomycin-Resistant Enterococcus faecium Bacteremia.

Vancomycin-resistant Enterococcus faecium bloodstream infections (VREF-BSI) cause significant mortality, highlighting the need to optimize their treatment. We compared the effectiveness and safety of daptomycin (DAP) and linezolid (LZD) as continuous or sequential therapy for VREF-BSI in a national, retrospective, propensity score (PS)-matched cohort study of hospitalized Veterans Affairs patients (2004 to 2014). We compared clinical outcomes and adverse events among patients treated with continuous LZD, continuous DAP, or sequential LZD followed by DAP (LZD-to-DAP). Secondarily, we analyzed the impact of infectious diseases (ID) consultation and source of VREF-BSI. A total of 2,630 patients were included in the effectiveness analysis (LZD [n = 1,348], DAP [n = 1,055], LZD-to-DAP [n = 227]). LZD was associated with increased 30-day mortality versus DAP (risk ratio [RR], 1.11; 95% confidence interval [CI], 1.01 to 1.22; P = 0.042). After PS matching, this relationship persisted (RR, 1.13; 95% CI, 1.02 to 1.26; P = 0.015). LZD-to-DAP switchers had lower mortality than those remaining on LZD (RR, 1.29; 95% CI, 1.03 to 1.63; P = 0.021), suggesting a benefit may still be derived with sequential therapy. LZD-treated patients experienced more adverse events, including a ≥50% reduction in platelets (RR, 1.07; 95% CI, 1.03 to 1.11; P = 0.001). DAP was associated with lower mortality than was LZD in patients with endocarditis (RR, 1.20; 95% CI, 1.02 to 1.41; P = 0.024); however, there was no statistically significant association between treatment group and mortality with regard to other sources of infection. Therefore, source of infection appears to be important in selection of patients most likely to benefit from DAP over LZD.

A 10-year profile of enterococcal bloodstream infections at a tertiary-care hospital in Japan.

The first aim of this study is to characterize the epidemiology of enterococcal bloodstream infections (BSIs) at a Japanese tertiary-care hospital. The second aim is to identify predictive factors for 30-day mortality. We conducted a single center retrospective observational study. All patients with enterococcal BSI between 2005 and 2014 were enrolled. Univariate and multivariate analysis were performed to evaluate predictive factors for 30-day mortality. A total of 410 patients with enterococcal BSI were enrolled. Enterococcus faecalis was identified in 200 patients (48.8%) and Enterococcus faecium in 124 patients (30.2%). Isolates were susceptible to ampicillin and vancomycin (67.3% and 97.8%, respectively). Isolates that were not susceptible to vancomycin were either Enterococcus casseliflavus or Enterococcus gallinarum. All strains of E.faecalis and 10.8% of E.faecium strains were susceptible to ampicillin. Thirty-day mortality was 24.8%. Predictive factors for 30-day mortality were Charlson Comorbidity Index (CCI) 1-2 (adjusted odds ratio [OR] 6.07, 95% confidence interval [CI]: 1.22-30.2), CCI 3-4 (adjusted OR 8.79, 95% CI: 1.70-45.4), CCI ≥5 (adjusted OR 17.6, 95% CI: 3.52-88.2), E.faecium bacteremia (adjusted OR 2.19, 95% CI: 1.27-3.76), Pitt Bacteremia Score (PBS) ≥5 (adjusted OR 15.1, 95% CI: 6.41-35.6), and source control (adjusted OR 0.39, 95% CI: 0.22-0.72). Vancomycin-resistant strains of E.faecalis and E.faecium were not seen in this cohort. In addition, all strains of E.faecalis and 10.8% of E.faecium strains were susceptible to ampicillin. Predictive factors for 30-day mortality were CCI score, E.faecium bacteremia, PBS score, and source control.

Colon cancer and enterococcus bacteremia co-affection: A dangerous alliance

Adenocarcinoma of the colorectal region is one of the leading causes of cancer-related mortality in the USA and hence an important public health concern. Enterococci are emerging as an important cause of infection in the elderly. While translocation of enteric bacteria into the bloodstream is a known phenomenon in patients with infectious, inflammatory or infiltrative conditions of the bowel, a causative link between Enterococcus bacteremia and colorectal cancer has not been established in medical literature. We report the case of a patient presenting with E. faecalis bacteremia who was also diagnosed with infiltrating adenocarcinoma of the rectum. We discuss a possible relationship between these two conditions.

RelA Mutant Enterococcus faecium with Multiantibiotic Tolerance Arising in an Immunocompromised Host.

ABSTRACTSerious bacterial infections in immunocompromised patients require highly effective antibacterial therapy for cure, and thus, this setting may reveal novel mechanisms by which bacteria circumvent antibiotics in the absence of immune pressure. Here, an infant with leukemia developed vancomycin-resistant Enterococcus faecium (VRE) bacteremia that persisted for 26 days despite appropriate antibiotic therapy. Sequencing of 22 consecutive VRE isolates identified the emergence of a single missense mutation (L152F) in relA, which constitutively activated the stringent response, resulting in elevated baseline levels of the alarmone guanosine tetraphosphate (ppGpp). Although the mutant remained susceptible to both linezolid and daptomycin in clinical MIC testing and during planktonic growth, it demonstrated tolerance to high doses of both antibiotics when growing in a biofilm. This biofilm-specific gain in resistance was reflected in the broad shift in transcript levels caused by the mutation. Only an experimental biofilm-targeting ClpP-activating antibiotic was able to kill the mutant strain in an established biofilm. The relA mutation was associated with a fitness trade-off, forming smaller and less-well-populated biofilms on biological surfaces. We conclude that clinically relevant relA mutations can emerge during prolonged VRE infection, causing baseline activation of the stringent response, subsequent antibiotic tolerance, and delayed eradication in an immunocompromised state.

Clinical Characteristics and Low Susceptibility to Daptomycin in Enterococcus faecium Bacteremia.

Enterococcus faecium has high levels of resistance to multiple antibiotics, and the mortality due to E. faecium bacteremia is high. Accordingly, E. faecium strains with low susceptibility to daptomycin are a concern in clinical practice. This study assessed the predictive factors and prognosis of patients with bacteremia due to E. faecium as well as the antimicrobial susceptibility, particularly to daptomycin, among E. faecium isolates. The medical records of patients admitted to Osaka City University Hospital with E. faecalis (n = 60) and E. faecium (n = 48) bacteremia between January 2011 and March 2016 were retrospectively reviewed. The E. faecalis group (mean age: 62.0 years) included 22 women, and the E. faecium group (mean age: 59.1 years) included 19 women. Predictive factors for infection, prognosis, and isolate antimicrobial susceptibilities were evaluated. The mean Sequential Organ Failure Assessment score and mortality rate did not differ between the two groups. The independent predictors of E. faecium bacteremia in multivariate analysis included quinolone use (p = 0.025), malignancy (p = 0.021), and prolonged hospitalization (p = 0.016). Cardiovascular disease was associated with a reduced risk of E. faecium bacteremia (p = 0.015). Notably, the percentage of E. faecium isolates with low daptomycin susceptibility was higher than that of E. faecalis (8.5% vs. 0%, p = 0.036). Thus, E. faecium should be considered when administering antibiotic therapy to patients with a history of these predictors. Furthermore, the use of daptomycin should be avoided in case of E. faecium with low susceptibility to daptomycin.

Endoscopic ultrasound-guided hepaticogastrostomy drainage of an excluded left hepatic lobe in a hybrid way with percutaneous assistance

A 48-year-old woman was referred for the management of an excluded left hepatic lobe (LHL) with recurrent cholangitis after right hepatectomy extended to the segment 1 and wedge resection of the segment 2 for the treatment of an occlusive metastatic adenocarcinoma of the sigmoid colon previously treated with neoadjuvant chemotherapy and local resection. The crossing of the stricture of the left intrahepatic bile ducts (LIHBDs) was not successful with endoscopic retrograde cholangiopancreatography (ERCP). A permanent percutaneous external biliary drainage was performed through segment 3 biliary branch, complicated with pain and bile leakage around the drain. A first attempt by endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) did not succeed given the absence of dilation of the LIHBD and mostly due to an unstable position induced by a small size of the remnant LHL. Then, a hybrid procedure was performed after changing the percutaneous drain for a 5Fr Arrow-Flex introducer that permitted the puncture of the external part of the introducer with an EUS transgastric EchoTip® 19G needle and insertion of a 0.025-inch guidewire directly into the LIHBD around the introducer. The introducer was removed and the guidewire was caught in the hepatic segment 2 by a percutaneous lasso to stabilize the 0.025-inch guidewire. An EUS-HGS was done after fistulization of the transhepatic tract by 6Fr cystotome and placement of a partially-covered self-expandable metal stents. The clinical course was uncomplicated under vancomycin for an Enterococcus faecium bacteremia, and then chemotherapy was restarted. EUS-HGS is clearly established as an alternative technique for biliary drainage in case of unsuccessful ERCP or altered anatomy, based on decisional algorithm, with a pooled technical success rate of 82%, clinical success rate of 97%, and adverse event rate of 23%. The success of this procedure depends on several factors and tips like the kind and length of the intragastric part of the prosthesis, angulation of the LIHBD, oversized dilation of the transhepatic tract, access to the liver segment 3, and shearing of the guidewire. The low volume of the LHL may also be a cause of technical failure that can be resolved by new procedures as described in this case.

Rituximab, etoposide, methylprednisolone, high-dose cytarabine, and cisplatin in the treatment of secondary hemophagocytic lymphohistiocytosis with classical Hodgkin lymphoma: a case report and review of the literature

BackgroundHemophagocytic lymphohistiocytosis is becoming an increasingly recognized disorder in adults. Classical Hodgkin lymphoma is a relatively uncommon etiology of hemophagocytic lymphohistiocytosis and may complicate treatment options. Rituximab, etoposide, methylprednisolone, high-dose cytarabine, and cisplatin are discussed here as a treatment regimen. Case presentationA 66-year-old Hispanic man previously in good health presented with a 1-month history of recurrent fevers, chills, and night sweats and a 3-week history of new onset jaundice. A bone marrow biopsy revealed a normocellular bone marrow with increased histiocytes with areas of hemophagocytic activity. He met five out of eight criteria for hemophagocytic lymphohistiocytosis diagnosis including fevers, pancytopenia, hemophagocytosis, ferritin of 23,292 ng/mL (>500 ng/mL), and soluble-CD25 of 15,330 pg/mL (>1033 pg/mL). A right cervical lymph node biopsy revealed CD15, CD30, MUM-1, and Epstein–Barr virus-encoded small ribonucleic acid-positive cells with morphologic findings of classical Hodgkin lymphoma, lymphocyte-rich subtype. He completed 2 weeks of hemophagocytic lymphohistiocytosis-directed therapy with etoposide and dexamethasone, but then was switched to rituximab, etoposide, methylprednisolone, high-dose cytarabine, and cisplatin due to minimal improvement in his pancytopenia and hepatic impairment. He completed one full cycle of rituximab, etoposide, methylprednisolone, high-dose cytarabine, and cisplatin with notable improvement in serial hepatic function panels and had an undetectable Epstein–Barr virus viral load. However, he eventually died due to complications of Enterococcus faecalis bacteremia and colonic microperforation in the setting of persistent pancytopenia.ConclusionsThis case discusses the challenges facing treatment of adult malignancy-associated hemophagocytic lymphohistiocytosis. Rituximab, etoposide, methylprednisolone, high-dose cytarabine, and cisplatin may be a viable option for patients with secondary hemophagocytic lymphohistiocytosis and Hodgkin lymphoma who cannot tolerate standard therapies due to hepatic impairment. Targeted therapy and immunotherapy are promising new areas of developing treatments.

Association of daptomycin use with resistance development in Enterococcus faecium bacteraemia—a 7-year individual and population-based analysis

ObjectiveIn this study we aimed to analyse the association between use of daptomycin and MICs of daptomycin in Enterococcus faecium bacteraemia. MethodsWe prospectively enrolled patients aged ≥18 years with E. faecium bacteraemia hospitalized at the University Hospital Basel from 2008 to 2014. We determined daptomycin MICs by Etests and used pulsed field gel electrophoresis to determine clonal relatedness. We recorded the defined daily dosages of daptomycin (DDDs) per 100 patient-days and clinical data from charts. We correlated daptomycin MIC with use of daptomycin in patients with recurrence/persistence. ResultsIn 195 E. faecium bacteraemias originating from 162 patients the median MIC for daptomycin was 2 mg/L (IQR 2–3); 30% (15.4%) isolates had a MIC ≥4 mg/L and 6 (3.1%) were resistant (MIC >4 mg/L) according to CLSI criteria. The usage of daptomycin increased more than four-fold from 0.36 DDDs/100 patient-days in 2008 to 1.6 in 2014. In 13 of 28 (42.9%) patients with a relapsing or persisting bacteraemia, the daptomycin MIC of the second isolate increased from a median of 2.0 to 2.5 mg/L (p 0.010); 3/13 (23.1%) developed resistance. All patients with the same clone in the first and second episode and an increase of daptomycin MIC had been treated with daptomycin (6/6 versus 1/7 p 0.005). ConclusionsDaptomycin MICs and Daptomycin usage increased over time. On an individual patient level daptomycin exposure was associated with an increased MIC in subsequent bacteraemia episodes. Diversity did not indicate a clonal origin and argues for a de novo development of resistance.

Risk Factors of Endocarditis in Patients With Enterococcus faecalis Bacteremia: External Validation of the NOVA Score.

The NOVA score is a recently developed diagnostic tool used to identify patients with increased risk of infective endocarditis (IE) among patients with Enterococcus faecalis bacteremia. We aimed to validate the NOVA score and to identify risk factors for IE. From 1 January 2010 to 31 December 2013, we included 647 consecutive patients with E. faecalis bacteremia. The NOVA score was used in a slightly adapted form; 2/2 positive blood cultures resulted in 5 points, unknown origin of infection in 4 points, prior valve disease in 2 points, and heart murmur in 1 point. IE was diagnosed in 78 patients (12%). Monomicrobial E. faecalis bacteremia (hazard ratio [HR], 3.60; 95% confidence interval [CI], 1.6-8.0), prosthetic heart valve (HR, 6.2; 95% CI, 3.8-10.1), male sex (HR, 2.0; 95% CI, 1.1-3.8), and community acquisition (HR, 1.8; 95% CI, 1.1-2.9) were independently associated with IE. The adapted NOVA score was applied in the 240 patients examined by echocardiography. A low score (<4) was found in 40 patients (17%), implying a low likelihood of IE. Of the 78 patients with IE, 76 had a high score (≥4), resulting in a sensitivity of 97%, specificity of 23%, a negative predictive value of 95%, and a positive predictive value of 38%. Monomicrobial E. faecalis bacteremia, community acquisition, prosthetic heart valve, and male sex are associated with increased risk of IE. In our retrospective cohort, the adapted NOVA score performed well, suggesting that it could be useful in guiding clinical decisions.

Influence of Minimum Inhibitory Concentration in Clinical Outcomes of Enterococcus faecium Bacteremia Treated With Daptomycin: Is it Time to Change the Breakpoint?

Daptomycin has become a front-line antibiotic for multidrug-resistant Enterococcus faecium bloodstream infections (BSIs). We previously showed that E. faecium strains with daptomycin minimum inhibitory concentrations (MICs) in the higher end of susceptibility frequently harbor mutations associated with daptomycin resistance. We postulate that patients with E. faecium BSIs exhibiting daptomycin MICs of 3-4 µg/mL treated with daptomycin are more likely to have worse clinical outcomes than those exhibiting daptomycin MICs ≤2 µg/mL. We conducted a multicenter retrospective cohort study that included adult patients with E. faecium BSI for whom initial isolates, follow-up blood culture data, and daptomycin administration data were available. A central laboratory performed standardized daptomycin MIC testing for all isolates. The primary outcome was microbiologic failure, defined as clearance of bacteremia ≥4 days after the index blood culture. The secondary outcome was all-cause in-hospital mortality. A total of 62 patients were included. Thirty-one patients were infected with isolates that exhibited daptomycin MICs of 3-4 µg/mL. Overall, 34 patients had microbiologic failure and 25 died during hospitalization. In a multivariate logistic regression model, daptomycin MICs of 3-4 µg/mL (odds ratio [OR], 4.7 [1.37-16.12]; P = .014) and immunosuppression (OR, 5.32 [1.20-23.54]; P = .028) were significantly associated with microbiologic failure. Initial daptomycin dose of ≥8 mg/kg was not significantly associated with evaluated outcomes. Daptomycin MICs of 3-4 µg/mL in the initial E. faecium blood isolate predicted microbiological failure of daptomycin therapy, suggesting that modification in the daptomycin breakpoint for enterococci should be considered.

Influence of MIC in Clinical Outcomes of Enterococcus faecium Bacteremia Treated With Daptomycin: Is It Time to Change the Breakpoint?

Influence of MIC in Clinical Outcomes of Enterococcus faecium Bacteremia Treated With Daptomycin: Is It Time to Change the Breakpoint?

Acute vancomycin-resistant enterococcal bacteraemia outbreak analysis in haematology patients: a case-control study

Abstract Introduction We report a retrospective case-control series of a vancomycin-resistant Enterococcus faecium (VRE) bacteraemia outbreak at a tertiary metropolitan hospital in Queensland, Australia. The outbreak occurred on a haematology ward between 8 and 14 February 2014, 6 weeks after a ward relocation. The aim was to determine risk factors related to progression from colonisation with VRE to bacteraemia. Methods The cases were patients with haematological malignancy and proven catheter-related VRE bacteraemia. Matched controls were selected from the same ward with similar underlying haematological diagnoses and proven gastrointestinal VRE colonisation without invasive infection. Results This study suggests that female sex, recent administration of total parenteral nutrition, right-sided catheter placement with odds ratios (OR) 1.99, gastrointestinal disruption (OR: 1.91), and dexamethasone administration (OR: 2.37) are potential risk factors for progression from colonisation to infection. Notably, given the small sample size, the 95% confidence intervals are wide ranging from 0.02 to 222. Conclusion While progression from colonisation with VRE to invasive disease is likely to be a complex multifactorial process, the results of this study suggest certain clinical variables that warrant enhanced vigilance to reduce this occurrence. Interestingly, recent relocation of the haematology ward may play a significant role in this outbreak. This study highlights the importance of good infection control practice and the need for additional studies to further delineate risk factors for invasive VRE infection.

Low-dose Gentamicin for Uncomplicated Enterococcus faecalis Bacteremia May be Nephrotoxic in Children.

Uncertainty exists regarding the role of synergistic gentamicin for uncomplicated Enterococcus faecalis bacteremia in children. We conducted a retrospective, observational study comparing clinical outcomes of children with E. faecalis bacteremia without endocarditis receiving ampicillin monotherapy with those receiving ampicillin along with low-dose gentamicin therapy. To account for nonrandom assignment of combination therapy, propensity score weighting was combined with multivariable regression to estimate the effect of combination therapy on duration of bacteremia, bacteremic relapse, and acute kidney injury (AKI). One hundred sixty-three (52%) patients received ampicillin with low-dose gentamicin, and 150 (48%) patients received ampicillin monotherapy. Incorporating propensity-score weighting with additional adjustment for source control measures, patients receiving combination therapy experienced bacterial clearance 10 hours faster than children receiving ampicillin monotherapy (adjusted mean difference 0.42; confidence interval (CI), .02 to .82; P = .04). Bacteremic relapse was similar between the two groups (17% vs 18%); adjusted hazards ratio (aHR) 1.12; 95% CI, .65 to 1.92. Children receiving low-dose gentamicin had approximately twice the risk of developing AKI compared to children not receiving this agent, adjusting for the receipt of additional nephrotoxins (aHR 1.94; 95% CI, 1.48-2.97). Our study suggests that for children with uncomplicated E. faecalis bacteremia, the addition of low-dose gentamicin may decrease the time to bacterial clearance by 10 hours but without any impact on recurrent bacteremia. However, with this potential benefit comes the increased likelihood of AKI. Low-dose gentamicin for the treatment of uncomplicated enterococcal bacteremia may pose harm to children with limited benefit.

Clinical Outcomes of Daptomycin for Vancomycin-resistant Enterococcus Bacteremia

PurposeIn light of recent evidence suggesting enhancement of daptomycin activity against vancomycin-resistant Enterococcus (VRE) by ampicillin and other β-lactam antibiotics, we evaluated the safety profile and clinical efficacy of daptomycin with and without concomitant β-lactam antimicrobials in the treatment of VRE (faecium or faecalis) bacteremia from multiple centers across the United States. MethodsData were collected retrospectively as part of a larger multicenter registry (The Cubicin Outcomes Registry and Experience). Efficacy and clinical outcomes in patients with VRE bacteremia who received at least 3 days of daptomycin with or without concomitant β-lactams were analyzed. Although all the cases involved daptomycin-susceptible VRE, additional analysis was performed to examine whether the adjunctive β-lactam would play a more pivotal role in cases where the daptomycin MIC was in the upper limit of the susceptibility range, indicating that daptomycin monotherapy efficacy may be relatively compromised compared with cases with lower daptomycin MICs. FindingsTwo hundred sixty-two patients from 33 hospitals were evaluated. Most patients had at least one significant comorbidity, such as solid-organ or bone marrow transplantation (16%), neutropenia (36%), dialysis dependency (20%), or critical illness (36%) requiring care in an intensive care unit. Overall treatment success was 86% (n = 225/262), and treatment success for patients taking concomitant β-lactams was 86% (n = 105/122). Logistic regression identified treatment failure to be associated with sepsis (odds ratio = 3.42; P = 0.009) and an elevated daptomycin MIC (3–4 µg/mL) (odds ratio = 3.23, P = 0.013). No significant increase in clinical failure was seen among patients with elevated daptomycin MIC who received concomitant β-lactam therapy (clinical success, 88% vs 79% for MIC ≤2 vs 3–4 µg/mL, respectively; P = 0.417). Of 262 patients, 33 (13%) experienced ≥1 adverse event possibly related to daptomycin (increased creatine kinase in 8 patients). ImplicationsOverall, daptomycin was effective and well tolerated for VRE bacteremia, with lower effectiveness noted with daptomycin MIC of 3 to 4 µg/mL. Concomitant β-lactam therapy with daptomycin may improve clinical outcomes in this setting. Further studies are needed to characterize the potential benefit of concomitant β-lactams with daptomycin.

Bacterial whole genome sequencing: the new frontier?

Background I was awarded the Mike and Carole Ralston award in 2013, which enabled me to go to England and acquire bacterial whole genome analysis skills at the Oxford Genomics Centre, Oxford University. Methods Through this collaboration, 139 Enterococcus faecium bacteraemia isolates (collected between 2005 and 2013) were sequenced on the Illumina platform prior to my arrival. A bioinformatics pipeline was subsequently developed to assemble and analyse the obtained data. A mapping approach was used to establish the core genome and de novo assembly methods were also used to assemble the van transposon, which encodes resistance to the first line antibiotic vancomycin in E. faecium . Phylogenetic relationships were then explored to investigate the emergence of resistance in this series of isolates. Results A core genome of 2.6 Mbp was established. Exploration of phylogenetic relationships confirmed the presence of recombination. These events were found to occur across housekeeping genes and may account for the lack of resolution with multi-locus sequence typing. The evolutionary relationships of vancomycin resistance emergence and isolate strains were similarly complex. Conclusions The complexity of bacterial whole genomes and resolution of analysis required will need to be optimised to allow real time application of these data.

Which Multidrug-Resitant Bacteria are Emerging in Patients with Hematological Malignancies?: One-Year Report.

The aim of this retrospective, observational study was to evaluate the outcomes of bacteremia attacks during neutropenic episodes caused by chemotherapy in patients with hematological cancers by assessing mortality, involved pathogens, antimicrobial therapy and treatment responses. Patients who were older than 14years of age and developed at least one neutropenic episode after chemotherapy to treat hematological cancer between November 2011 and November 2012 were included in the study. We retrospectively collected demographic, treatment, and survival data for 68 patients with 129 neutropenic episodes. The mean age was 59.36±15.22years (range 17-80years), and 41 cases were male. The mean Multinational Association of Supportive Care in Cancer score was 19.56±9.04. A total of 37 (28%) bacteremia attacks were recorded in 20 cases (29%). Fatality rates were 50% in the six cases with bacteremia caused by carbapenem-resistant Gram-negative bacteria; death occurred in two patients with carbapenem-resistant Acinetobacter baumannii and in one patient with carbapenem-resistant Pseudomonas aeruginosa. Clinical and microbiological responses were achieved using PIP-TAZ or CEP-SUL treatment in 80% (16/20) of the cases with bacteremia caused by carbapenem-sensitive Gram-negative bacteria (CS-GNB). During 547 colonization-days in 21 (30%) vancomycin-resistant enterococci (VRE)-colonized cases among 68 patients, vancomycin-resistant Enterococcus faecium bacteremia developed in two patients. Non-carbapenem-based therapy can cure most bacteremia attacks caused by CS-GNB in patients with hematological cancer. However, bacteremia and other infections caused by drug-resistant pathogens, such as A. baumannii, P. aeruginosa, and VRE, are a growing concern in hematological patients.

Vancomycin-Resistant and Daptomycin-Resistant Enterococcus faecium Bacteremia and Colonization in Patients With Acute Leukemia With Prolonged Neutropenia

Vancomycin-Resistant and Daptomycin-Resistant Enterococcus faecium Bacteremia and Colonization in Patients With Acute Leukemia With Prolonged Neutropenia

Enterococcus faecalis bacteremia and mitral valve endocarditis under dabigatran for stroke prevention

Enterococcus faecalis bacteremia and mitral valve endocarditis under dabigatran for stroke prevention

Glycopeptide use is associated with increased mortality in Enterococcus faecalis bacteraemia.

Enterococci are an important cause of nosocomial and community-acquired infections, with bacteraemia being one of the most common presentations. Although inappropriate antimicrobial therapy has been associated with poorer outcomes in Enterococcus faecalis (EF) bacteraemia, the impact of antimicrobial choice, namely β-lactam versus glycopeptide therapy, has not been well described. We sought to determine whether choice of antibiotic affects patient outcomes in EF bacteraemia. This retrospective cohort study was conducted at Liverpool and Bankstown Lidcombe Hospitals, Sydney, Australia between 2006 and 2013. Medical records and laboratory data for consecutive EF bacteraemias were reviewed. Clinical and microbiological data were obtained for all patients who received appropriate antimicrobial therapy with either a β-lactam or a glycopeptide antibiotic. Outcomes and predictors of mortality were determined and treatment groups were compared. One hundred and seventy-two episodes of clinically significant EF bacteraemias received appropriate antimicrobial therapy with a β-lactam (n = 126) or a glycopeptide (n = 46). All-cause 30 day mortality was 15.1%, with mortality significantly higher in patients receiving glycopeptide therapy compared with β-lactam therapy (26.1% versus 11.1%, P = 0.015). Glycopeptide therapy remained an independent predictor of 30 day mortality [OR 2.46 (95% CI 1.01-6.02), P = 0.048]. APACHE II score [OR 1.10 (95% CI 1.02-1.18), P = 0.011] and malignancy [OR 2.58 (95% CI 1.03-6.49), P = 0.044] were also independent predictors of 30 day mortality. Glycopeptide use is associated with increased mortality in patients with EF bacteraemia. In the treatment of β-lactam-susceptible EF bacteraemia, β-lactams should be considered first-line therapy.