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Clinical Features and Genomic Epidemiology of Bloodstream Infections due to Enterococcal Species Other Than Enterococcus faecalis or E. faecium in Patients With Cancer.
- Source :
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Open forum infectious diseases [Open Forum Infect Dis] 2024 May 17; Vol. 11 (6), pp. ofae288. Date of Electronic Publication: 2024 May 17 (Print Publication: 2024). - Publication Year :
- 2024
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Abstract
- Background: Non- Enterococcus faecium, non- E. faecalis (NFF) enterococci are a heterogeneous group of clinically pathogenic enterococci that include species with intrinsic low-level vancomycin resistance. Patients with cancer are at increased risk for bacteremia with NFF enterococci, but their clinical and molecular epidemiology have not been extensively described.<br />Methods: We conducted a retrospective review of all patients (n = 70) with NFF bacteremia from 2016 to 2022 at a major cancer center. The main outcomes assessed were 30-day mortality, microbiological failure (positive blood cultures for ≥4 days), and recurrence of bacteremia (positive blood culture <14 days after clearance). Whole-genome sequencing was performed on all available NFF (n = 65).<br />Results: Patients with hematological malignancies made up 56% of the cohort (77% had leukemia). The majority of solid malignancies (87%) were gastrointestinal in origin. The majority of infections (83%) originated from an intra-abdominal source. The most common NFF species were E. gallinarum (50%) and E. casseliflavus (30%). Most (61%) patients received combination therapy. Bacteremia recurred in 4.3% of patients, there was a 30-day mortality of 23%, and 4.3% had microbiological failure. E. gallinarum and E. casseliflavus isolates were genetically diverse with no spatiotemporal clustering to suggest a single strain. Frequencies of ampicillin resistance (4.3%) and daptomycin resistance (1.9%) were low. Patients with hematologic malignancy had infections with NFF enterococci that harbored more resistance genes than patients with solid malignancy ( P = .005).<br />Conclusions: NFF bacteremia is caused by a heterogeneous population of isolates and is associated with significant mortality. Hematological malignancy is an important risk factor for infection with NFF resistant to multiple antibiotics.<br />Competing Interests: Potential conflicts of interest. C.A.A. reports royalties from UpToDate. W.R.M. reports royalties from UpToDate and support from Merck. All other authors report no conflicts.<br /> (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Details
- Language :
- English
- ISSN :
- 2328-8957
- Volume :
- 11
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Open forum infectious diseases
- Publication Type :
- Academic Journal
- Accession number :
- 38835498
- Full Text :
- https://doi.org/10.1093/ofid/ofae288