Question

Discuss an article on incident of a poor outcome or fatality related to the infection of VRE.

Answer 1

Ans) Vancomycin resistance showed some trend towards increasing 30-day mortality, but is not statistically significant despite the delayed use of adequate antibiotics (≥48 hours). Only underlying severity of medical condition predicts poor outcome in a relatively homogeneous group of neutropenic patients.

- Enterococcal bloodstream infections (BSI) have been increasing in hospitalized patients since the 1990s. Enterococci are normal intestinal flora of humans, but usually cause infections when immunity of the host is compromised. At our Blood and Marrow Transplantation Center, Enterococcus has emerged as the third most common pathogen, constituting 14.0% of all BSIs, and vancomycin resistant Enterococcus (VRE) was responsible for 20.6% of proven enterococcal BSIs. There are several studies on outcomes after administration of newer antimicrobial agents such as linezolid, daptomycin, quinupristin-dalfopristin or tigecycline. But VRE BSI is still a major concern, because of the limited therapeutic options available and higher mortality subsequent to infection.

- It has been demonstrated that vancomycin resistance increases mortality in patients with enterococcal BSI, however, controversy remains. Conflicting results on the clinical implications of vancomycin resistance may have been due to the varied severity of the underlying illness in patients with VRE BSI. Previous meta-analysis concluded that vancomycin resistance is independently associated with increased mortality in enterococcal BSI. However, only a subset of the studies involved in the meta-analysis examined immunocompromised individuals.

- Whether vancomycin resistance increases mortality in patients with enterococcal BSI could be one of the important considerations in determining empirical therapeutic approach, especially in the setting of chemotherapy-induced reversible neutropenia. This study examined the risk factors and outcomes of VRE BSI as compared with vancomycin-susceptible Enterococcus (VSE) BSI, and the factors associated with mortality in a relatively homogeneous group of patients with neutropenia after chemotherapy or stem cell transplantation (SCT) for underlying hematologic diseases.