Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: a nested case-control study.
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Authors
Gouliouris, Theodore
Cartwright, Edward JP
Bedford, Luke
Weerasuriya, Chathika K
Raven, Kathy E
Brown, Nick M
Török, M Estée
Limmathurotsakul, Direk
Peacock, Sharon J
Publication Date
2018-06-01Journal Title
J Antimicrob Chemother
ISSN
0305-7453
Publisher
Oxford University Press (OUP)
Volume
73
Issue
6
Pages
1692-1699
Language
eng
Type
Article
Physical Medium
Print
Metadata
Show full item recordCitation
Gouliouris, T., Warne, B., Cartwright, E. J., Bedford, L., Weerasuriya, C. K., Raven, K. E., Brown, N. M., et al. (2018). Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: a nested case-control study.. J Antimicrob Chemother, 73 (6), 1692-1699. https://doi.org/10.1093/jac/dky075
Abstract
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.
Keywords
Adult, Aged, Anti-Bacterial Agents, Antimicrobial Stewardship, Bacteremia, Case-Control Studies, Cross Infection, Enterococcus, Female, Gram-Positive Bacterial Infections, Humans, Intensive Care Units, Logistic Models, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, United Kingdom, Vancomycin, Vancomycin Resistance
Sponsorship
Academy of Medical Sciences (unknown)
Wellcome Trust (103387/Z/13/Z)
Medical Research Council (MR/N029399/1)
Wellcome Trust (098600/Z/12/Z)
National Institute for Health Research (HICF-T5-342)
Identifiers
External DOI: https://doi.org/10.1093/jac/dky075
This record's URL: https://www.repository.cam.ac.uk/handle/1810/282936
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