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Title: Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: A nested case-control study
Authors: 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 J. Peacock
Public Health England
London School of Hygiene & Tropical Medicine
University of Cambridge
Cambridge University Hospitals NHS Foundation Trust
Mahidol University
Keywords: Medicine;Pharmacology, Toxicology and Pharmaceutics
Issue Date: 1-Jun-2018
Citation: Journal of Antimicrobial Chemotherapy. Vol.73, No.6 (2018), 1692-1699
Abstract: © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. 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.
ISSN: 14602091
Appears in Collections:Scopus 2018

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