doiSerbia

Risk factors for vancomycin-resistant Enterococcus colonization in hematologic patients

Mioljević Vesna (Clinical Center of Serbia, Department of Hospital Epidemiology and Hygiene, Belgrade)
Marković-Denić Ljiljana (Faculty of Medicine, Institute of Epidemiology, Belgrade)
Vidović Ana (Clinical Center of Serbia, Clinic of Hematology, Belgrade + Faculty of Medicine, Belgrade)
Jovanović Milica (Clinical Center of Serbia, Microbiology Department, Belgrade)
Tošić Tanja (Clinical Center of Serbia, Microbiology Department, Belgrade)
Tomin Dragica (Clinical Center of Serbia, Clinic of Hematology, Belgrade + Faculty of Medicine, Belgrade)

Background/Aim. Vancomycin-resistant Enterococci (VRE) is one of the most important hospital pathogens. The aim of the study was to evaluate VRE colonization in patients hospitalized at the Hematology Intensive Care Unit, as well as the associated risk factors. Methods. A prospective cohort study involved 70 patients hospitalized at the Intensive Care Unit (ICU), Clinic for Hematology, Clinical Center of Serbia, Belgrade, during 3 months. Baseline demographic data, data about antibiotic usage and other risk factors for VRE colonization during the present and previous hospitalizations (within 6 months) were recorded for each patient using the questionnaire. Feces or rectal swab was collected for culture from patients on admission and at discharge in case when VRE was not isolated on admission. Enterococci were isolated by standard microbiological methods. Isolate sensitivity was tested by disk-diffusion test using 30 μg/mL (BBL) Vancomycin plates according to the Clinical and Laboratory Standards Institute (CLSI) standard. Results. Analysing results showed that 7% of the patients had been already colonized with VRE upon ICU admission. The rate of VRE colonization during present hospitalization was 41.5%. Univariate logistic regression demonstrated the statistically significant differences in diagnosis, length of present stay, use of aminoglycosides and piperacillin/tazobactam in present hospitalization, duration of use of carbapenem and piperacillin/ tazobactam in present hospitalization between the VREcolonized and non-colonized patients. Acute myeloid leukemia (AML), use of carbapenem in previous hospitalization and duration of use of piperacillin/tazobactam in present hospitalization were independent risk factors for VRE-colonized patients according to multivariate logistic regression. Conclusion. VRE colonization rate was high among the patients admitted to hematology ICU. Rational use of antibiotics and active surveillance may be helpful preventive measures against the development of bacterial resistance to antimicrobial agents.

Keywords: enterococcus faecium, vancomycin, drug resistance, bacterial, hematologic diseases, risk factors

Projekat Ministarstva nauke Republike Srbije, br. 175046