Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: a nested case-control study

June 10, 2018 at 7:20 pm

Journal of Antimicrobial Chemotherapy June 2018 V.73 N.6 P.1692–1699

Theodore Gouliouris; Ben Warne; Edward J P Cartwright; Luke Bedford; Chathika K Weerasuriya …

Background

VRE bacteraemia has a high mortality and continues to defy control. Antibiotic risk factors for VRE bacteraemia have not been adequately defined. We aimed to determine the risk factors for VRE bacteraemia focusing on duration of antibiotic exposure.

Methods

A retrospective matched nested case-control study was conducted amongst hospitalized patients at Cambridge University Hospitals NHS Foundation Trust (CUH) from 1 January 2006 to 31 December 2012. Cases who developed a first episode of VRE bacteraemia were matched 1:1 to controls by length of stay, year, specialty and ward type. Independent risk factors for VRE bacteraemia were evaluated using conditional logistic regression.

Results

Two hundred and thirty-five cases were compared with 220 controls. Duration of exposure to parenteral vancomycin, fluoroquinolones and meropenem was independently associated with VRE bacteraemia. Compared with patients with no exposure to vancomycin, those who received courses of 1–3 days, 4–7 days or >7 days had a stepwise increase in risk of VRE bacteraemia [conditional OR (cOR) 1.2 (95% CI 0.4–3.8), 3.8 (95% CI 1.2–11.7) and 6.6 (95% CI 1.9–22.8), respectively]. Other risk factors were: presence of a central venous catheter (CVC) [cOR 8.7 (95% CI 2.6–29.5)]; neutropenia [cOR 15.5 (95% CI 4.2–57.0)]; hypoalbuminaemia [cOR 8.5 (95% CI 2.4–29.5)]; malignancy [cOR 4.4 (95% CI 1.6–12.0)]; gastrointestinal disease [cOR 12.4 (95% CI 4.2–36.8)]; and hepatobiliary disease [cOR 7.9 (95% CI 2.1–29.9)].

Conclusions

Longer exposure to vancomycin, fluoroquinolones or meropenem was associated with VRE bacteraemia. Antimicrobial stewardship interventions targeting high-risk antibiotics are required to complement infection control procedures against VRE bacteraemia.

FULL TEXT

https://academic.oup.com/jac/article/73/6/1692/4934161

PDF (CLIC en PDF)

Advertisements

Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Metodos diagnosticos, REPORTS, Resistencia bacteriana, Sepsis, Update.

Respiratory Syncytial Virus During Pregnancy Antibiotic Resistance and the Risk of Recurrent Bacteremia


Calendar

June 2018
M T W T F S S
« May   Jul »
 123
45678910
11121314151617
18192021222324
252627282930  

Most Recent Posts


%d bloggers like this: