Characteristics and Prevalence of Vancomycin-variable Enterococcus faecium bacteremia in southern Taiwan.

IF 4.5 2区医学 Q2 IMMUNOLOGY Journal of Microbiology Immunology and Infection Pub Date : 2024-08-24 DOI:10.1016/j.jmii.2024.08.006

Chi-Jung Lu, Wei-Chun Hung, Zi-Han Lan, Po-Liang Lu, Chun-Yu Lin, Yen-Hsu Chen, Tun-Chieh Chen, Chung-Hao Huang, Ya-Ting Chang, Chun-Yuan Lee, Yu-Te Tsai, Shang-Yi Lin

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Abstract

Background: Vancomycin-variable enterococci (VVE) are vanA-carrying Enterococcus faecium that are phenotypically susceptible to vancomycin and can only be detected using molecular methods, leading to the possibility of treatment failure and posing threats to infection control. This study aimed to determine the prevalence of VVE and its associated clinical risk factors.

Methods: This retrospective study was conducted in two hospitals in southern Taiwan. Patients with phenotypically vancomycin-susceptible E. faecium bacteremia were enrolled between 2017 and 2021. VVEs were defined as isolates harboring the vanA gene that were phenotypically susceptible to vancomycin. Vancomycin-susceptible E. faecium (VSE) isolates were phenotypically susceptible to vancomycin and lacked vanA or vanB genes.

Results: Of the 142 enrolled patients, 121 (85.2%) had VSE and 21 (14.8%) had VVE. Resistance rates to penicillin, tetracycline, and fosfomycin were higher in VVE isolates. Malignancy (adjusted odds ratio [aOR] = 4.87; 95% confidence interval [CI] 1.54-15.41, p = 0.007) and central venous catheter usage (aOR = 4.69; 95% CI 1.49-14.78, p = 0.008) were the independent risk factors associated with VVE bacteremia. Being male (aOR = 0.12, CI 0.03-0.44, p = 0.002) was less likely to be associated with VVE bacteremia. Although VVE was not associated with 30-day mortality (38.1% [VVE] vs. 35.5% [VSE], p = 0.822), one case of subsequent vancomycin-resistant enterococci infection in the VVE group with vancomycin treatment (4.8%, 1/21) was identified, which led to subsequent mortality.

Conclusions: The prevalence of VVE was high among E. faecium isolates with vancomycin-susceptible phenotypes in southern Taiwan. Although the current study revealed that VVE bacteremia was not associated with poor clinical outcome, further multicenter surveillance survey is recommended to evaluate the possible impact of VVE on public health in Taiwan.

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台湾南部万古霉素变异性粪肠球菌菌血症的特征和流行率。

背景：万古霉素变异性肠球菌（VVE）是一种携带万古霉素表型易感性的粪肠球菌，只能通过分子方法检测，可能导致治疗失败并对感染控制构成威胁。本研究旨在确定VVE的发病率及其相关临床风险因素：这项回顾性研究在台湾南部的两家医院进行。2017年至2021年期间，表型为万古霉素易感粪肠球菌菌血症的患者被纳入研究。VVE被定义为携带vanA基因且表型上对万古霉素敏感的分离株。万古霉素敏感粪肠球菌（VSE）分离株对万古霉素表型敏感，但缺乏vanA或vanB基因：结果：在 142 名入选患者中，121 人（85.2%）有 VSE，21 人（14.8%）有 VVE。VVE 分离物对青霉素、四环素和磷霉素的耐药率较高。恶性肿瘤（调整后比值比 [aOR] = 4.87；95% 置信区间 [CI] 1.54-15.41，p = 0.007）和使用中心静脉导管（aOR = 4.69；95% CI 1.49-14.78，p = 0.008）是与 VVE 菌血症相关的独立风险因素。男性（aOR = 0.12，CI 0.03-0.44，p = 0.002）与 VVE 菌血症相关的可能性较小。虽然 VVE 与 30 天死亡率无关（38.1% [VVE] vs. 35.5% [VSE]，p = 0.822），但在接受万古霉素治疗的 VVE 组中发现了一例随后感染耐万古霉素肠球菌的病例（4.8%，1/21），这导致了随后的死亡：结论：在台湾南部具有万古霉素敏感表型的粪肠球菌分离株中，VVE的流行率很高。尽管目前的研究表明，VVE菌血症与不良临床结果无关，但建议进一步开展多中心监测调查，以评估VVE对台湾公共卫生可能造成的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Microbiology Immunology and Infection IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

15.90

自引率

5.40%

发文量

159

审稿时长

67 days

期刊介绍： Journal of Microbiology Immunology and Infection is an open access journal, committed to disseminating information on the latest trends and advances in microbiology, immunology, infectious diseases and parasitology. Article types considered include perspectives, review articles, original articles, brief reports and correspondence. With the aim of promoting effective and accurate scientific information, an expert panel of referees constitutes the backbone of the peer-review process in evaluating the quality and content of manuscripts submitted for publication.