 |
|
The Association Between Antecedent Vancomycin Treatment and Hospital-Acquired Vancomycin-Resistant Enterococci
A Meta-analysis
Yehuda Carmeli, MD, MPH;
Matthew H. Samore, MD;
W. Charles Huskins, MD, MPH
Arch Intern Med. 1999;159:2461-2468.
Background The association between vancomycin hydrochloride treatment and vancomycin-resistant enterococci (VRE) has been investigated in numerous studies with variable results.
Objectives To conduct a meta-analysis to estimate the magnitude of the association between vancomycin treatment and individual risk of VRE and to identify study characteristics that accounted for heterogeneity in study results.
Methods Studies were identified using MEDLINE with index terms "Enterococcus," "Enterococcus faecalis," or "Enterococcus faecium" and "vancomycin," "drug resistance," "drug resistance, microbial," or "drug resistance, multiple or risk factors." Reports from conferences and reference lists of recent reviews were used. A total of 420 published reports and 98 conference reports were reviewed; 20 studies described in 15 published reports were included in the analysis. We recorded study period, hospital setting, case and control definitions, length of hospital stay, method of adjustment for differences in length of stay, and data on treatment with vancomycin. The odds ratio (OR) of vancomycin treatment provided the measure of association analyzed. A random-effects model was used to estimate the pooled OR.
Results When results from all 20 studies were combined, the pooled OR was 4.5 (95% confidence interval, 3.0-6.9), but the test for heterogeneity was highly significant (P<.001). The 5 studies that used patients with vancomycin-susceptible enterococci as controls found a stronger association (pooled OR, 10.7; 95% confidence interval, 4.8-23.8) than the 15 studies that used controls who had no VRE isolated (pooled OR, 2.7; 95% confidence interval, 2.0-3.8). After restricting the analysis to the latter studies only, no heterogeneity was evident in the unadjusted study results. Patients with VRE had stayed in the hospital much longer than control patients. Studies that adjusted for this difference found only a small and nonsignificant association between vancomycin treatment and VRE (pooled OR, 1.4; 95% confidence interval, 0.74-2.60). We also detected publication bias, favoring report of studies that found a large measure of association.
Conclusions The reported strong association between vancomycin treatment and hospital-acquired VRE results from the selection of the reference group, confounding by duration of hospitalization, and publication bias. Studies that accounted for these factors found only a small and nonsignificant association.
From the Divisions of Infectious Diseases, Beth Israel Deaconess Medical Center (Drs Carmeli and Samore), Children's Hospital (Dr Huskins), and Harvard Medical School (Drs Carmeli, Samore, and Huskins), Boston, Mass. Dr Carmeli is now with the Division of Infectious Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 1999;159(20):2492-2493.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Bacteraemia associated with a vancomycin-resistant Enterococcus gallinarum strain harbouring both the vanA and vanC1 genes
Merquior et al.
J Med Microbiol 2008;57:244-245.
ABSTRACT
| FULL TEXT
Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis
Tacconelli et al.
J Antimicrob Chemother 2008;61:26-38.
ABSTRACT
| FULL TEXT
Evidence for Biliary Excretion of Vancomycin into Stool during Intravenous Therapy: Potential Implications for Rectal Colonization with Vancomycin-Resistant Enterococci
Currie and Lemos-Filho
Antimicrob. Agents Chemother. 2004;48:4427-4429.
ABSTRACT
| FULL TEXT
The Magnitude of the Association between Fluoroquinolone Use and Quinolone-Resistant Escherichia coli and Klebsiella pneumoniae May Be Lower than Previously Reported
Bolon et al.
Antimicrob. Agents Chemother. 2004;48:1934-1940.
ABSTRACT
| FULL TEXT
Role of Environmental Contamination as a Risk Factor for Acquisition of Vancomycin-Resistant Enterococci in Patients Treated in a Medical Intensive Care Unit
Martinez et al.
Arch Intern Med 2003;163:1905-1912.
ABSTRACT
| FULL TEXT
The Commonality of Risk Factors for Nosocomial Colonization and Infection with Antimicrobial-Resistant Staphylococcus aureus, Enterococcus, Gram-Negative Bacilli, Clostridium difficile, and Candida
Safdar and Maki
ANN INTERN MED 2002;136:834-844.
ABSTRACT
| FULL TEXT
Effects of Antibiotics on Nosocomial Epidemiology of Vancomycin-Resistant Enterococci
Harbarth et al.
Antimicrob. Agents Chemother. 2002;46:1619-1628.
FULL TEXT
Antimicrobial Resistance: Guidelines for the Practicing Orthopaedic Surgeon
Osmon
JBJS 2001;83:1891-1901.
FULL TEXT
Prior trimethoprim use and trimethoprim-resistant urinary tract infection: a nested case-control study with multivariate analysis for other risk factors
Steinke et al.
J Antimicrob Chemother 2001;47:781-787.
ABSTRACT
| FULL TEXT
Risk Factors for Recovery of Ampicillin-Sulbactam-Resistant Escherichia coli in Hospitalized Patients
Kaye et al.
Antimicrob. Agents Chemother. 2000;44:1004-1009.
ABSTRACT
| FULL TEXT
|
