Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-05T04:56:29.221Z Has data issue: false hasContentIssue false
  • English
  • Français

Decrease in vancomycin-resistant Enterococcus colonization associated with a reduction in carbapenem use as empiric therapy for febrile neutropenia in patients with acute leukemia

Published online by Cambridge University Press:  03 May 2019

Clyde D. Ford ,
Jana Coombs ,
Michaela Gazdik Stofer ,
Bert K. Lopansri ,
Brandon J. Webb ,
Fabiana Ostronoff ,
Julie Asch  and
Daanish Hoda
Clyde D. Ford*
Affiliation:
Intermountain Acute Leukemia Program, LDS Hospital, Salt Lake City, Utah
Jana Coombs
Affiliation:
Department of Medicine, Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
Michaela Gazdik Stofer
Affiliation:
Department of Biology, Utah Valley University, Orem, Utah
Bert K. Lopansri
Affiliation:
Department of Medicine, Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah
Brandon J. Webb
Affiliation:
Department of Medicine, Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
Fabiana Ostronoff
Affiliation:
Intermountain Acute Leukemia Program, LDS Hospital, Salt Lake City, Utah
Julie Asch
Affiliation:
Intermountain Acute Leukemia Program, LDS Hospital, Salt Lake City, Utah
Daanish Hoda
Affiliation:
Intermountain Acute Leukemia Program, LDS Hospital, Salt Lake City, Utah
*
Author for correspondence: Clyde D. Ford, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To compare the effects of empiric carbapenems versus cycling cefepime and piperacillin/tazobactam on the rates of vancomycin-resistant Enterococcus (VRE) colonization, bloodstream infections, and outcomes of patients admitted with acute leukemia.

Design:

Retrospective clinical study with VRE molecular strain typing and gastrointestinal microbiome comparison.

Setting:

A regional referral center for acute leukemia.

Patients:

342 consecutive patients admitted with newly diagnosed acute leukemia.

Methods:

In September 2015, we changed our empiric antibiotic of choice for neutropenic fever from a carbapenem to the cycling regimen. We studied 214 consecutive patients during the carbapenem period and 128 during the cycling period. Surveillance for VRE stool colonization was conducted weekly. Representative stool samples were analyzed for VRE MLST types and changes in the composition and diversity of the fecal microbiota.

Results:

The change in empiric antibiotics was associated with a significant decrease in VRE colonization (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.27–0.66), a switch in the dominant VRE MLST types on the unit, and some modifications in the gastrointestinal microbiome. There were no differences in total gram-positive or gram-negative BSIs. During the carbapenem period, we observed higher absolute numbers of Candida spp and fewer ESBL BSIs, but these did not reach statistical significance. Patients during the carbapenem period had longer lengths of stay and durations of severe neutropenia and 10% higher hospital cost.

Conclusions:

Carbapenem-sparing empiric antibiotic regimens may have advantages related to VRE ecology, gastrointestinal dysbiosis, duration of neutropenia, cost and length of stay.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 7 , July 2019 , pp. 774 - 779
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Worth, LJ, Thursky, KA, Seymour, JF, Slavin, MA. Vancomycin-resistant Enterococcus faecium infection in patients with hematologic malignancy: patients with acute myeloid leukemia are at high risk. Eur J Haematol 2007;79:226–233.CrossRefGoogle ScholarPubMed
Ford, CD, Lopansri, BK, Haydoura, S, et al. Frequency, risk factors, and outcomes of vancomycin-resistant Enterococcus colonization and infection in patients with newly diagnosed acute leukemia: different patterns in patients with acute myelogenous and acute lymphoblastic leukemia. Infect Control Hosp Epidemiol 2015;36:47–53.CrossRefGoogle ScholarPubMed
Bach, PB, Malak, SF, Jurcic, J. Impact of infection by vancomycin-resistant Enterococcus on survival and resource utilization for patients with leukemia. Infect Control Hosp Epidemiol 2002;23:471–474.CrossRefGoogle ScholarPubMed
Homan, WL, Tribe, D, Poznanski, S, et al. Multilocus sequence typing scheme for Enterococcus faecium . J Clin Microbiol 2002;40:1963–1971.CrossRefGoogle ScholarPubMed
Raad, II, Escalante, C, Hachem, RY, et al. Treatment of febrile neutropenic patients with cancer who require hospitalization: a prospective randomized study comparing imipenem and cefepime. Cancer 2003;98:1039–1047.CrossRefGoogle ScholarPubMed
Gorschluter, M, Hahn, C, Fixson, A, et al. Piperacillin-tazobactam is more effective than ceftriaxone plus gentamicin in febrile neutropenic patients with hematological malignancies: a randomized comparison. Support Care Cancer 2003;11:362–370.Google ScholarPubMed
Hashino, S, Morita, L, Kanamori, H, et al. Clinical impact of cycling the administration of antibiotics for febrile neutropenia in Japanese patients with hematological malignancy. Eur J Clin Microbiol Infect Dis 2012;31:173–178.CrossRefGoogle ScholarPubMed
Cumpston, A, Craig, M, Hamadani, M, Abraham, J, Hobbs, GR, Sarwari, AR. Extended follow-up of an antibiotic cycling program for the management of febrile neutropenia in a hematologic malignancy and hematopoietic cell transplant unit. Transpl Infect Dis 2013;15:142–149.CrossRefGoogle Scholar
Chong, Y, Shimoda, S, Yakushiji, H, et al. Antibiotic rotation for febrile neutropenic patients with hematological malignancies: clinical significance of antibiotic heterogeneity. PLoS One 2013;8:e54190.CrossRefGoogle ScholarPubMed
Caballero, S, Kim, S, Carter, RA, et al. Cooperating commensals restore colonization resistance to vancomycin-resistant Enterococcus faecium . Cell Host Microbe 2017;21:592–602.CrossRefGoogle ScholarPubMed
Jenq, RR, Taur, Y, Devlin, SM, et al. Intestinal Blautia is associated with reduced death from graft-versus-host disease. Biol Blood Marrow Transplant 2015;21:1373–1383.CrossRefGoogle ScholarPubMed
Oztoprak, N, Piskin, N, Aydemir, H, et al. Piperacillin-tazobactam versus carbapenem therapy with and without amikacin as empirical treatment of febrile neutropenia in cancer patients: results of an open randomized trial at a university hospital. Jpn J Clin Oncol 2010;40:761–767.CrossRefGoogle Scholar
Roohullah, A, Moniwa, A, Wood, C, et al. Imipenem versus piperacillin/tazobactam for empiric treatment of neutropenic fever in adults. Int Med J 2013;43:1151–1154.CrossRefGoogle ScholarPubMed
Biron, P, Fuhrmann, C, Cure, H, et al. Cefepime versus imipenem-cilastatin as empirical monotherapy in 400 febrile patients with short duration neutropenia. J Antimicrobial Chemother 1998;42:511–518.CrossRefGoogle ScholarPubMed
Cherif, H, Bjorkholm, M, Engervall, P, et al. A prospective, randomized study comparing cefepime and imipenem-cilastatin in the empirical treatment of febrile neutropenia in patients treated for haematological malignancies. Scand J Infect Dis 2004;36:593–600.CrossRefGoogle ScholarPubMed
Nakane, T, Tamura, K, Hino, M, et al. Cefozopran, meropenem, or imipenem-cilastin compared with cefepime as empirical therapy in febrile neutropenic adult patients: a multicenter prospective randomized trial. J Infect Chemother 2015;21:16–22.CrossRefGoogle Scholar
Michael, KE, No, D, Roberts, MC. VanA-positive multidrug-resistant Enterococcus spp isolated from surfaces of a US hospital laundry facility. J Hosp Infect 2017;95:218–223.CrossRefGoogle Scholar
Marchi, AP, Perdigao Neto, LV, Martins, RCR, et al. Vancomycin-resistant enterococci isolates colonizing and infecting haematology patients: clonality, and virulence and resistance profile. J Hosp Infect 2018;99:346–355.CrossRefGoogle ScholarPubMed