Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: A nested case-control study

Theodore Gouliouris; Ben Warne; Edward J.P. Cartwright; Luke Bedford; Chathika K. Weerasuriya; Kathy E. Raven; Nick M. Brown; M. Estée Török; Direk Limmathurotsakul; Sharon Peacock

doi:10.1093/jac/dky075

Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: A nested case-control study

Theodore Gouliouris^*, Ben Warne, Edward J.P. Cartwright, Luke Bedford, Chathika K. Weerasuriya, Kathy E. Raven, Nick M. Brown, M. Estée Török, Direk Limmathurotsakul, Sharon Peacock

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

23 Citations (Scopus)

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 meropenemwas associated with VRE bacteraemia. Antimicrobial stewardship interventions targeting high-risk antibiotics are required to complement infection control procedures against VRE bacteraemia.

Original language	English
Pages (from-to)	1692-1699
Number of pages	8
Journal	Journal of Antimicrobial Chemotherapy
Volume	73
Issue number	6
DOIs	https://doi.org/10.1093/jac/dky075
Publication status	Published - 1 Jun 2018

Bibliographical note

Funding Information:
T. G. is a Wellcome Trust Research Training Fellow (grant number: 103387/ Z/13/Z) and has received support from Public Health England. B. W. is an Academic Clinical Fellow supported by the National Institute for Health Research. M. E. T. is a Clinician Scientist Fellow supported by the Academy of Medical Sciences and the Health Foundation and is also supported by the National Institute for Health Research Cambridge Biomedical Research Centre. This work was also supported by the Health Innovation Challenge Fund (WT098600, HICF-T5–342), a parallel funding partnership between the Department of Health and Wellcome Trust.

Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

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10.1093/jac/dky075

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Gouliouris, T., Warne, B., Cartwright, E. J. P., Bedford, L., Weerasuriya, C. K., Raven, K. E., Brown, N. M., Török, M. E., Limmathurotsakul, D., & Peacock, S. (2018). Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: A nested case-control study. Journal of Antimicrobial Chemotherapy, 73(6), 1692-1699. https://doi.org/10.1093/jac/dky075

Gouliouris, Theodore ; Warne, Ben ; Cartwright, Edward J.P. ; Bedford, Luke ; Weerasuriya, Chathika K. ; Raven, Kathy E. ; Brown, Nick M. ; Török, M. Estée ; Limmathurotsakul, Direk ; Peacock, Sharon. / Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia : A nested case-control study. In: Journal of Antimicrobial Chemotherapy. 2018 ; Vol. 73, No. 6. pp. 1692-1699.

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title = "Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: A nested case-control study",

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 meropenemwas associated with VRE bacteraemia. Antimicrobial stewardship interventions targeting high-risk antibiotics are required to complement infection control procedures against VRE bacteraemia.",

author = "Theodore Gouliouris and Ben Warne and Cartwright, {Edward J.P.} and Luke Bedford and Weerasuriya, {Chathika K.} and Raven, {Kathy E.} and Brown, {Nick M.} and T{\"o}r{\"o}k, {M. Est{\'e}e} and Direk Limmathurotsakul and Sharon Peacock",

note = "Funding Information: T. G. is a Wellcome Trust Research Training Fellow (grant number: 103387/ Z/13/Z) and has received support from Public Health England. B. W. is an Academic Clinical Fellow supported by the National Institute for Health Research. M. E. T. is a Clinician Scientist Fellow supported by the Academy of Medical Sciences and the Health Foundation and is also supported by the National Institute for Health Research Cambridge Biomedical Research Centre. This work was also supported by the Health Innovation Challenge Fund (WT098600, HICF-T5–342), a parallel funding partnership between the Department of Health and Wellcome Trust. Publisher Copyright: {\textcopyright} The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.",

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doi = "10.1093/jac/dky075",

language = "English",

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journal = "Journal of Antimicrobial Chemotherapy",

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Gouliouris, T, Warne, B, Cartwright, EJP, Bedford, L, Weerasuriya, CK, Raven, KE, Brown, NM, Török, ME, Limmathurotsakul, D & Peacock, S 2018, 'Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: A nested case-control study', Journal of Antimicrobial Chemotherapy, vol. 73, no. 6, pp. 1692-1699. https://doi.org/10.1093/jac/dky075

Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia : A nested case-control study. / Gouliouris, Theodore; Warne, Ben; Cartwright, Edward J.P.; Bedford, Luke; Weerasuriya, Chathika K.; Raven, Kathy E.; Brown, Nick M.; Török, M. Estée; Limmathurotsakul, Direk; Peacock, Sharon.

In: Journal of Antimicrobial Chemotherapy, Vol. 73, No. 6, 01.06.2018, p. 1692-1699.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia

T2 - A nested case-control study

AU - Gouliouris, Theodore

AU - Warne, Ben

AU - Cartwright, Edward J.P.

AU - Bedford, Luke

AU - Weerasuriya, Chathika K.

AU - Raven, Kathy E.

AU - Brown, Nick M.

AU - Török, M. Estée

AU - Limmathurotsakul, Direk

AU - Peacock, Sharon

N1 - Funding Information: T. G. is a Wellcome Trust Research Training Fellow (grant number: 103387/ Z/13/Z) and has received support from Public Health England. B. W. is an Academic Clinical Fellow supported by the National Institute for Health Research. M. E. T. is a Clinician Scientist Fellow supported by the Academy of Medical Sciences and the Health Foundation and is also supported by the National Institute for Health Research Cambridge Biomedical Research Centre. This work was also supported by the Health Innovation Challenge Fund (WT098600, HICF-T5–342), a parallel funding partnership between the Department of Health and Wellcome Trust. Publisher Copyright: © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - 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 meropenemwas associated with VRE bacteraemia. Antimicrobial stewardship interventions targeting high-risk antibiotics are required to complement infection control procedures against VRE bacteraemia.

AB - 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 meropenemwas associated with VRE bacteraemia. Antimicrobial stewardship interventions targeting high-risk antibiotics are required to complement infection control procedures against VRE bacteraemia.

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JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

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ER -

Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: A nested case-control study

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