Annals for Hospitalists Inpatient Notes - Clinical Pearls—Enterococcal Bacteremia

2020 ◽  
Vol 173 (10) ◽  
pp. HO2-HO3
Author(s):  
Rachael A. Lee
Keyword(s):  
Enterococcal Bacteremia

scholarly journals Prevalence and Detection of Mixed-Population Enterococcal Bacteremia

2014 ◽  
Vol 52 (7) ◽  
pp. 2604-2608 ◽  
Author(s):  
A. M. Cardenas ◽  
K. A. Andreacchio ◽  
P. H. Edelstein
Keyword(s):  
Mixed Population ◽  
Enterococcal Bacteremia

scholarly journals Clinical Features and Rate of Infective Endocarditis in Non-Faecalis and Non-faecium Enterococcal Bacteremia

2011 ◽  
Vol 47 (2) ◽  
pp. 111 ◽  
Author(s):  
Hee-Chang Jang ◽  
Wan Beom Park ◽  
Hong Bin Kim ◽  
Eui-Chong Kim ◽  
Myoung-don Oh
Keyword(s):  
Infective Endocarditis ◽  
Clinical Features ◽  
Enterococcal Bacteremia

scholarly journals Pharmacodynamic Analysis of Daptomycin-treated Enterococcal Bacteremia: It Is Time to Change the Breakpoint

2018 ◽  
Vol 68 (10) ◽  
pp. 1650-1657 ◽  
Author(s):  
Lindsay M Avery ◽  
Joseph L Kuti ◽  
Maja Weisser ◽  
Adrian Egli ◽  
Michael J Rybak ◽  
...  
Keyword(s):  
Regression Tree ◽  
Classification And Regression Tree ◽  
Population Pharmacokinetic ◽  
Time Curve ◽  
Regression Tree Analysis ◽  
Lactam Antibiotic ◽  
Infection Source ◽  
High Doses ◽  
Susceptibility Breakpoint ◽  
Enterococcal Bacteremia

Abstract Background Currently, there is debate over whether the daptomycin susceptibility breakpoint for enterococci (ie, minimum inhibitory concentration [MIC] ≤4 mg/L) is appropriate. In bacteremia, observational data support prescription of high doses (>8 mg/kg). However, pharmacodynamic targets associated with positive patient outcomes are undefined. Methods Data were pooled from observational studies that assessed outcomes in daptomycin-treated enterococcal bacteremia. Patients who received an additional antienterococcal antibiotic and/or a β-lactam antibiotic at any time during treatment were excluded. Daptomycin exposures were calculated using a published population pharmacokinetic model. The free drug area under the concentration-time curve to MIC ratio (fAUC/MIC) threshold predictive of survival at 30 days was identified by classification and regression tree analysis and confirmed with multivariable logistic regression. Monte Carlo simulations determined the probability of target attainment (PTA) at clinically relevant MICs. Results Of 114 patients who received daptomycin monotherapy, 67 (58.8%) were alive at 30 days. A fAUC/MIC >27.43 was associated with survival in low-acuity (n = 77) patients (68.9 vs 37.5%, P = .006), which remained significant after adjusting for infection source and immunosuppression (P = .026). The PTA for a 6-mg/kg/day (every 24 hours) dose was 1.5%–5.5% when the MIC was 4 mg/L (ie, daptomycin-susceptible) and 91.0%–97.9% when the MIC was 1 mg/L. Conclusions For enterococcal bacteremia, a daptomycin fAUC/MIC >27.43 was associated with 30-day survival among low-acuity patients. As pharmacodynamics for the approved dose are optimized only when MIC ≤1 mg/L, these data continue to stress the importance of reevaluation of the susceptibility breakpoint.

scholarly journals Vancomycin-resistant Enterococcal Bacteremia in a Hematology Unit: Molecular Epidemiology and Analysis of Clinical Course

2005 ◽  
Vol 20 (2) ◽  
pp. 169 ◽  
Author(s):  
Jin-Hong Yoo ◽  
Dong-Gun Lee ◽  
Su Mi Choi ◽  
Jung-Hyun Choi ◽  
Wan-Shik Shin ◽  
...  
Keyword(s):  
Molecular Epidemiology ◽  
Clinical Course ◽  
Vancomycin Resistant ◽  
Enterococcal Bacteremia

scholarly journals 622. The Accessory Genome in Enterococcal Bacteremia: Results from the Vancomycin-Resistant Enterococcal Bacteremia Outcomes Study (VENOUS)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S289-S289
Author(s):  
Shelby Simar ◽  
Blake Hanson ◽  
German Contreras ◽  
Katherine Reyes ◽  
Pranoti V Sahasrabhojane ◽  
...  
Keyword(s):  
Resistance Genes ◽  
Significant Proportion ◽  
Genetic Material ◽  
Advisory Board ◽  
Hospital System ◽  
Accessory Genome ◽  
Pan Genome ◽  
Long Read ◽  
Vancomycin Resistant ◽  
Enterococcal Bacteremia

Abstract Background Vancomycin-resistant enterococci (VRE) are a major cause of nosocomial bloodstream infections. Enterococci exhibit remarkable genomic plasticity and can recombine through the acquisition of genetic material via mobile genetic elements (MGEs), including resistance genes. The accessory genome plays a major role in the evolution of enterococci within the human host. Thus, dissecting the entire genome (pan-genome) is of paramount importance to characterize the population structure of enterococci causing disease. Methods VENOUS is an ongoing prospective, observational study of adults with enterococcal bacteremia. From September 2016 to March 2018, E. faecalis (Efs) and E. faecium (Efm) were collected in 14 hospitals of a single hospital system and a major cancer center in Houston, TX, and a general hospital in Detroit, MI. Short- and long-read genomic sequencing were performed with Illumina MiSeq and Oxford Nanopore Technologies GridION X5, respectively. A proprietary bioinformatics pipeline was utilized for genome assembly and further analyses. Results 156 Efs and 98 Efm isolates from single patients were analyzed. The average proportion of core genes in each genome was 64.6% (53.0–74.1) and 49.1% (45.2–51.0) for Efs and Efm, respectively. The vanA gene cluster was identified in 5.1% (8/157) of Efs and 57.1% (56/98) of Efm. The plasmid-encoded aac(6′)-Ie-aph(2″)-Ia gene conferring high-level resistance to aminoglycosides was found in 37.6% (59/157) Efs, seven of which also possessed vanA. Long-read sequencing of vanA-harboring plasmids from a subset of VRE revealed that the vanA cluster was carried in plasmids ranging from 31.7 to 132.3 kb. Although the vanA operon was fairly conserved, insertions of MGE were identified in the intergenic regions of vanS/vanH and vanX/vanY. Furthermore, a variety of MGE insertions mediated integration of the vanA operon, including IS1216 and IS256 (figure). Conclusion Accessory genes, including AMR genes, comprise a significant proportion of the enterococcal pan-genome, indicating major genetic plasticity within these organisms. Acquired resistance genes seem to have a high degree of recombination and play a substantial role in the expansion of the genomic repertoire in clinical isolates. Disclosures Samuel L. Aitken, PharmD, Melinta Therapeutics: Grant/Research Support, Research Grant; Merck, Sharpe, and Dohme: Advisory Board; Shionogi: Advisory Board.

Enterococcal bacteremia in febrile neutropenic children and adolescents with underlying malignancies, and clinical impact of vancomycin resistance

Infection ◽  
2018 ◽  
Vol 47 (3) ◽  
pp. 417-424 ◽  
Author(s):  
Kil-Seong Bae ◽  
Ju Ae Shin ◽  
Seong koo Kim ◽  
Seung Beom Han ◽  
Jae Wook Lee ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Vancomycin Resistance ◽  
Clinical Impact ◽  
Enterococcal Bacteremia
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