Catheter-Related Vancomycin-ResistantEnterococcus FaeciumBacteremia: Clinical and Molecular Epidemiology

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Abstract
Objective: : To study the clinical and molecular epidemiology of vancomycin-resistantEnterococcus faeciumorganisms causing catheter-related bacteremia in patients with cancer.Design: : Retrospective case-control study.Setting: : University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas.Patients: : Case-patients were patients with cancer who had catheter-related vancomycin-resistantE. faeciumbacteremia and control-patients were patients with cancer and vancomycin-resistantE. faeciumgastrointestinal colonization without infection.Results: : Ten case-patients with catheter-related vancomycin-resistantE. faeciumbacteremia were compared with 30 control-patients with gastrointestinal colonization by vancomycin-resistantE. faecium. Patients with catheter-related vancomycin-resistantE. faeciumbacteremia were more likely to have required mechanical ventilation (P< .01), received total parenteral nutrition (P< .01), and had polyurethane catheters (P< .01) inserted in the femoral vein (P= .01). With the use of pulsed-fleld gel electrophoresis, 4 of the 10 catheter-related vancomycin-resistantE. faeciumbacteremia isolates were genetically indistinguishable, whereas only 2 of the 30 control vancomycin-resistantE. faeciumisolates displayed this same DNA pattern (P= .03).Conclusion: : This study suggests that catheter-related vancomycin-resistantE. faeciumbacteremia occurs more frequently in patients who receive total parenteral nutrition, mechanical ventilation, and femoral catheters. (Infect Control Hosp Epidemiol 2005;26:658-661)