Gut Colonization with Vancomycin-resistant and Risk for Subsequent Enteric Infection

Overview

Journal Gut Pathog

Publisher Biomed Central

Specialty Gastroenterology

Date 2018 Jul 14

PMID 30002733

Citations 10

Authors

Jordan E Axelrad

Benjamin Lebwohl

Edward Cuaresma

Ken Cadwell

Peter H R Green

Daniel E Freedberg

Affiliations

Soon will be listed here.

Abstract

Background: Gut colonization with vancomycin-resistant (VRE) is associated with poor outcomes. This study evaluated the impact of VRE colonization on subsequent acquisition of enteric pathogens.

Methods: We performed a retrospective cohort study of adults admitted to an ICU from 2012 to 2017 who were screened for VRE colonization and subsequently underwent stool testing with a gastrointestinal pathogen PCR panel (GI PCR) with or without PCR testing for . Our primary outcome was the presence of any enteric pathogen. Cox proportional hazards modeling was used to adjust for factors associated with enteric infection.

Results: Of 761 patients who underwent VRE screening and subsequent GI PCR, 131 (17%) were colonized with VRE. Patients with VRE colonization were less likely to test positive on GI PCR compared to patients without VRE (9.2% vs 18%, p = 0.01); specifically for species (p = 0.03) and viral (p = 0.04) enteric infections. In 716 patients who underwent testing, there was a trend towards more infections in patients colonized with VRE (15% vs 10%, p = 0.11). On multivariable analysis, patients with VRE had a decreased risk of a positive GI PCR (aHR 0.47, 95% CI 0.25-0.88, p = 0.02) but not infection, effects which persisted during 5 years of follow-up. Among positive tests, there was a greater proportion of with VRE (57% vs 28%, p < 0.01).

Conclusions: VRE colonization was associated with a decreased risk of subsequent non- enteric infection. VRE domination of the gut microbiome may protect against acquisition of common enteric pathogens.

Citing Articles

Coumarin Glycosides Reverse Enterococci-Facilitated Enteric Infections.

Xu W, Yuan G, Fang Y, Liu X, Ma X, Zhu K Research (Wash D C). 2024; 7:0374.

PMID: 38756989 PMC: 11096794. DOI: 10.34133/research.0374.

Multi-omics analysis of hospital-acquired diarrhoeal patients reveals biomarkers of enterococcal proliferation and Clostridioides difficile infection.

Bosnjak M, Karpe A, Van T, Kotsanas D, Jenkin G, Costello S Nat Commun. 2023; 14(1):7737.

PMID: 38007555 PMC: 10676382. DOI: 10.1038/s41467-023-43671-8.

Returning to Nature for the Next Generation of Antimicrobial Therapeutics.

MacNair C, Tsai C, Rutherford S, Tan M Antibiotics (Basel). 2023; 12(8).

PMID: 37627687 PMC: 10451936. DOI: 10.3390/antibiotics12081267.

and 's Interplay in the Human Gut: Bacterial Alliance or Competition? A Systematic Literature Review.

Granata G, Schiavone F, Taglietti F, Petrosillo N J Clin Med. 2023; 12(15).

PMID: 37568399 PMC: 10420055. DOI: 10.3390/jcm12154997.

Antibiotic Susceptibility Patterns and Virulence-Associated Factors of Vancomycin-Resistant Enterococcal Isolates from Tertiary Care Hospitals.

Backiam A, Duraisamy S, Karuppaiya P, Balakrishnan S, Chandrasekaran B, Kumarasamy A Antibiotics (Basel). 2023; 12(6).

PMID: 37370300 PMC: 10295198. DOI: 10.3390/antibiotics12060981.

References

Haverkate M, Derde L, Brun-Buisson C, Bonten M, Bootsma M . Duration of colonization with antimicrobial-resistant bacteria after ICU discharge. Intensive Care Med. 2014; 40(4):564-71. PMC: 3969519. DOI: 10.1007/s00134-014-3225-8. View

Axelrad J, Joelson A, Nobel Y, Lawlor G, Green P, Lichtiger S . Enteric Infection in Relapse of Inflammatory Bowel Disease: The Utility of Stool Microbial PCR Testing. Inflamm Bowel Dis. 2017; 23(6):1034-1039. DOI: 10.1097/MIB.0000000000001097. View

Gao W, Howden B, Stinear T . Evolution of virulence in Enterococcus faecium, a hospital-adapted opportunistic pathogen. Curr Opin Microbiol. 2017; 41:76-82. DOI: 10.1016/j.mib.2017.11.030. View

Arias C, Murray B . The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol. 2012; 10(4):266-78. PMC: 3621121. DOI: 10.1038/nrmicro2761. View

Axelrad J, Joelson A, Nobel Y, Whittier S, Lawlor G, Riddle M . The Distribution of Enteric Infections Utilizing Stool Microbial Polymerase Chain Reaction Testing in Clinical Practice. Dig Dis Sci. 2018; 63(7):1900-1909. DOI: 10.1007/s10620-018-5087-3. View

Vincent C, Miller M, Edens T, Mehrotra S, Dewar K, Manges A . Bloom and bust: intestinal microbiota dynamics in response to hospital exposures and Clostridium difficile colonization or infection. Microbiome. 2016; 4:12. PMC: 4791782. DOI: 10.1186/s40168-016-0156-3. View

Reddington K, Tuite N, Minogue E, Barry T . A current overview of commercially available nucleic acid diagnostics approaches to detect and identify human gastroenteritis pathogens. Biomol Detect Quantif. 2016; 1(1):3-7. PMC: 5129431. DOI: 10.1016/j.bdq.2014.07.001. View

Buss S, Leber A, Chapin K, Fey P, Bankowski M, Jones M . Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol. 2015; 53(3):915-25. PMC: 4390666. DOI: 10.1128/JCM.02674-14. View

Jung E, Byun S, Lee H, Moon S, Lee H . Vancomycin-resistant Enterococcus colonization in the intensive care unit: clinical outcomes and attributable costs of hospitalization. Am J Infect Control. 2014; 42(10):1062-6. DOI: 10.1016/j.ajic.2014.06.024. View

10.

Byndloss M, Olsan E, Rivera-Chavez F, Tiffany C, Cevallos S, Lokken K . Microbiota-activated PPAR-γ signaling inhibits dysbiotic Enterobacteriaceae expansion. Science. 2017; 357(6351):570-575. PMC: 5642957. DOI: 10.1126/science.aam9949. View

11.

Freeman K, Mistry H, Tsertsvadze A, Royle P, McCarthy N, Taylor-Phillips S . Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis. Health Technol Assess. 2017; 21(23):1-188. PMC: 5494512. DOI: 10.3310/hta21230. View

12.

Rupnik M, Wilcox M, Gerding D . Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol. 2009; 7(7):526-36. DOI: 10.1038/nrmicro2164. View

13.

Chang S, Sievert D, Hageman J, Boulton M, Tenover F, Downes F . Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N Engl J Med. 2003; 348(14):1342-7. DOI: 10.1056/NEJMoa025025. View

14.

Nobel Y, Axelrad J, Lewis S, Whittier S, Lawlor G, Lichtiger S . Stool PCR for Gastrointestinal Pathogens in Patients With and Without Immune-Mediated Intestinal Diseases. Dig Dis Sci. 2018; 63(4):996-1002. DOI: 10.1007/s10620-018-4959-x. View

15.

Bonten M, Willems R, Weinstein R . Vancomycin-resistant enterococci: why are they here, and where do they come from?. Lancet Infect Dis. 2002; 1(5):314-25. DOI: 10.1016/S1473-3099(01)00145-1. View

16.

Sohn K, Peck K, Joo E, Ha Y, Kang C, Chung D . Duration of colonization and risk factors for prolonged carriage of vancomycin-resistant enterococci after discharge from the hospital. Int J Infect Dis. 2012; 17(4):e240-6. DOI: 10.1016/j.ijid.2012.09.019. View

17.

Taur Y, Xavier J, Lipuma L, Ubeda C, Goldberg J, Gobourne A . Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clin Infect Dis. 2012; 55(7):905-14. PMC: 3657523. DOI: 10.1093/cid/cis580. View

18.

Scallan E, Griffin P, Angulo F, Tauxe R, Hoekstra R . Foodborne illness acquired in the United States--unspecified agents. Emerg Infect Dis. 2011; 17(1):16-22. PMC: 3204615. DOI: 10.3201/eid1701.091101p2. View

19.

Amberpet R, Sistla S, Parija S, Thabah M . Screening for Intestinal Colonization with Vancomycin Resistant Enterococci and Associated Risk Factors among Patients Admitted to an Adult Intensive Care Unit of a Large Teaching Hospital. J Clin Diagn Res. 2016; 10(9):DC06-DC09. PMC: 5071930. DOI: 10.7860/JCDR/2016/20562.8418. View

20.

Papadimitriou-Olivgeris M, Drougka E, Fligou F, Kolonitsiou F, Liakopoulos A, Dodou V . Risk factors for enterococcal infection and colonization by vancomycin-resistant enterococci in critically ill patients. Infection. 2014; 42(6):1013-22. DOI: 10.1007/s15010-014-0678-1. View