Janković, Aleksandar

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Vancomycin-resistant enterococci colonization within hemodialysis population- single centre experience

Mitrović, Miloš; Janjušević, Ana; Ćurčić, Petar; Janković, Aleksandar; Popović, Jovan

(Oxford Univ Press, Oxford, 2017) 

TY  - CONF
AU  - Mitrović, Miloš
AU  - Janjušević, Ana
AU  - Ćurčić, Petar
AU  - Janković, Aleksandar
AU  - Popović, Jovan
PY  - 2017
UR  - http://intor.torlakinstitut.com/handle/123456789/495
AB  - INTRODUCTION AND AIMS: Vancomycin-resistant Enterococci (VRE) colonization is common occurrence in hemodialysis patients, due to direct contact in closed dialysis setting, frequent hospitalizations and antibiotic use. Apart from epidemiological concern the high percentage of VRE carriers increase the risk of invasive infection outbreaks, with high morbidity and mortality in immunocompromised. The aim of this cross sectional single-centre study was to investigate the prevalence and risk factors for VRE colonization and infection among hemodialysis patients.

METHODS: Stool samples from 169 asymptomatic hemodialysis patients were obtained and cultured on enterococcosel agar with 6 μg/ml Vancomycin. Multiple regression analysis was used when studying the correlation of VRE colonization with demographic data, laboratory results, comorbidities, vascular access and previous hospitalization or antibiotic use inside of 30-day period. All patients were followed-up during 11 months, in order to asses the potential VRE infection development.

RESULTS: Coproculture of 49 patients (28.9%) showed the presence of VRE. Previous hospitalization inside 30 days, proved to be the most important risk factor for VRE development (OR 4.3, CI 1.4-10.4, p=0,014). Previous antibiotic (OR 2.2, CI 1.1-4-5, p=0.047), especially Vancomycin therapy (OR 3.5, CI 1.2-10.7, p=0.021), increased the odds of VRE colonization. We also found that VRE-colonized patients didn't have significantly higher inflammatory markers, but tended to have lower hemoglobin levels (10.2 vs 10.6 g/L, p= 0.025) with higher erythropoietin demand (5105 vs 3246 IU/week, p= 0.037). During follow-up, 11 patients (7%), of which 6 previously defined as VRE colonized, developed VRE infection. We didn't prove VRE colonization as significant risk factor for VRE infection development, but, if we observe only VRE colonized patients with central venous catheter as vascular access, they had 13.8 times higher odds of being VRE infected (OR 13.8, CI 2.7- 23.6, p=0.0014).

CONCLUSIONS: High VRE colonization rate in hemodialysis setting may increase the odds of subsequent infection among patients with central venous catheters. This finding emphasize importance of regular screening and cautious hygienic and antimicrobial practice.
PB  - Oxford Univ Press, Oxford
C3  - Nephrology Dialysis Transplantation
T1  - Vancomycin-resistant enterococci colonization within hemodialysis population- single centre experience
IS  - suppl_3
VL  - 32
DO  - 10.1093/ndt/gfx180.MP719
UR  - https://hdl.handle.net/21.15107/rcub_intor_495
ER  - 
@conference{
author = "Mitrović, Miloš and Janjušević, Ana and Ćurčić, Petar and Janković, Aleksandar and Popović, Jovan",
year = "2017",
abstract = "INTRODUCTION AND AIMS: Vancomycin-resistant Enterococci (VRE) colonization is common occurrence in hemodialysis patients, due to direct contact in closed dialysis setting, frequent hospitalizations and antibiotic use. Apart from epidemiological concern the high percentage of VRE carriers increase the risk of invasive infection outbreaks, with high morbidity and mortality in immunocompromised. The aim of this cross sectional single-centre study was to investigate the prevalence and risk factors for VRE colonization and infection among hemodialysis patients.

METHODS: Stool samples from 169 asymptomatic hemodialysis patients were obtained and cultured on enterococcosel agar with 6 μg/ml Vancomycin. Multiple regression analysis was used when studying the correlation of VRE colonization with demographic data, laboratory results, comorbidities, vascular access and previous hospitalization or antibiotic use inside of 30-day period. All patients were followed-up during 11 months, in order to asses the potential VRE infection development.

RESULTS: Coproculture of 49 patients (28.9%) showed the presence of VRE. Previous hospitalization inside 30 days, proved to be the most important risk factor for VRE development (OR 4.3, CI 1.4-10.4, p=0,014). Previous antibiotic (OR 2.2, CI 1.1-4-5, p=0.047), especially Vancomycin therapy (OR 3.5, CI 1.2-10.7, p=0.021), increased the odds of VRE colonization. We also found that VRE-colonized patients didn't have significantly higher inflammatory markers, but tended to have lower hemoglobin levels (10.2 vs 10.6 g/L, p= 0.025) with higher erythropoietin demand (5105 vs 3246 IU/week, p= 0.037). During follow-up, 11 patients (7%), of which 6 previously defined as VRE colonized, developed VRE infection. We didn't prove VRE colonization as significant risk factor for VRE infection development, but, if we observe only VRE colonized patients with central venous catheter as vascular access, they had 13.8 times higher odds of being VRE infected (OR 13.8, CI 2.7- 23.6, p=0.0014).

CONCLUSIONS: High VRE colonization rate in hemodialysis setting may increase the odds of subsequent infection among patients with central venous catheters. This finding emphasize importance of regular screening and cautious hygienic and antimicrobial practice.",
publisher = "Oxford Univ Press, Oxford",
journal = "Nephrology Dialysis Transplantation",
title = "Vancomycin-resistant enterococci colonization within hemodialysis population- single centre experience",
number = "suppl_3",
volume = "32",
doi = "10.1093/ndt/gfx180.MP719",
url = "https://hdl.handle.net/21.15107/rcub_intor_495"
}
Mitrović, M., Janjušević, A., Ćurčić, P., Janković, A.,& Popović, J.. (2017). Vancomycin-resistant enterococci colonization within hemodialysis population- single centre experience. in Nephrology Dialysis Transplantation
Oxford Univ Press, Oxford., 32(suppl_3).
https://doi.org/10.1093/ndt/gfx180.MP719
https://hdl.handle.net/21.15107/rcub_intor_495
Mitrović M, Janjušević A, Ćurčić P, Janković A, Popović J. Vancomycin-resistant enterococci colonization within hemodialysis population- single centre experience. in Nephrology Dialysis Transplantation. 2017;32(suppl_3).
doi:10.1093/ndt/gfx180.MP719
https://hdl.handle.net/21.15107/rcub_intor_495 .
Mitrović, Miloš, Janjušević, Ana, Ćurčić, Petar, Janković, Aleksandar, Popović, Jovan, "Vancomycin-resistant enterococci colonization within hemodialysis population- single centre experience" in Nephrology Dialysis Transplantation, 32, no. suppl_3 (2017),
https://doi.org/10.1093/ndt/gfx180.MP719 .,
https://hdl.handle.net/21.15107/rcub_intor_495 .