Increased Bloodstream Infections in Cancer Patients Due to Enterococcus faecium (2006-2012)

What is it about?

A prospective study was conducted to assess risk factors, molecular epidemiology, and outcomes of bloodstream infections (BSI) due to Enterococcus faecium in hospitalized cancer patients. Between 2006 and 2012, a significant increase in vancomycin-susceptible E. faecium BSI was observed among cancer patients. Previous use of carbapenems was the only independent risk factor for E. faecium acquisition. All 30 isolates available for genotyping belonged to hospital-associated E. faecium lineages. Patients with E. faecium BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with E. faecalis BSI. The emergence of E. faecium among cancer patients is a concern, as there are limited treatment options, and it may presage the emergence of vancomycin-resistant enterococci. A rational approach that combines infection control with antimicrobial stewardship is needed.

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Why is it important?

This study is important because it provides valuable insights into the risk factors, molecular epidemiology, and outcomes of bloodstream infections (BSI) caused by Enterococcus faecium in hospitalized cancer patients. As antimicrobial resistance continues to evolve, it is crucial to understand the factors contributing to the emergence of vancomycin-susceptible E. faecium, which is a concern due to its limited treatment options and potential to presage the emergence of vancomycin-resistant enterococci. Key Takeaways: 1. The incidence of E. faecium BSI increased significantly over time, while the incidence of E. faecalis BSI remained stable. 2. Previous use of carbapenems was identified as the only independent risk factor for E. faecium acquisition. 3. All E. faecium isolates were susceptible to glycopeptides, but 97% showed high-level resistance to ampicillin and ciprofloxacin. 4. Patients with E. faecium BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with E. faecalis BSI, and time to adequate empirical antibiotic therapy was longer in the former group. 5. Independent risk factors for overall case-fatality were current corticosteroids and intensive care unit admission.