Vancomycin Resistant Enterococcus Bacteraemia in an Endemic Region: Clinical Features and Genomic Analysis, a 12-Year Cohort.
J Hosp Infect, 2021/12/08;
Lybdeh OA[1], Murik O[2], Oster Y[3], Assous MV[4], Mann T[2], Zeevi DA[2], Benensson S[5], Wiener-Well Y[1]
Affiliations
PMID: 34896188DOI: 10.1016/j.jhin.2021.11.021
Impact factor: 8.944
Abstract
background: Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens with an increasing prevalence worldwide. Hospitals in Jerusalem, Israel, are known to have high rates of VRE carriage. The clonicity of this pathogen, in endemic areas, is still not clear.
methods: We reviewed the medical files of patients with VRE bacteraemia (n=182) who were hospitalized in the three major hospitals in Jerusalem, from 2009 to 2020. These were compared to 100 patients with Vancomycin-susceptible enterococcus (VSE) bacteraemia, during the same period, and their clinical and demographic characters were analyzed. Then, whole genome sequencing (WGS) of the VRE isolates was performed; the results were analyzed considering the demographic, epidemiologic and clinical outcome data.
results: Patients with VRE bacteraemia had higher rate of central lines, hematologic malignancies and immunosuppression compared to patients with VSE bacteraemia (63% vs 27%, p<0.001; 25% vs 13%, p=0.02; 24% vs 13%, p=0.04 respectively). Patients with VRE bacteraemia had a significantly increased 7 and 30 days in-hospital-mortality (31% vs 18%, p= 0.02; 57% vs 34%, p<0.001 respectively) and a longer mean hospital stay (39 vs 24 days, p= 0.005). The WGS results of VRE isolates showed diversity rather than endemicity of a single clone. No clones were associated with specific ethnicity, geographical distribution, or worse prognosis.
conclusions: WGS revealed the occurrence of small unrelated outbreaks rather than the expansion of large clusters in the city of Jerusalem. VRE bacteraemia was found in sicker patients and was associated with higher mortality and longer hospital stay compared to VSE bacteraemia.
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