TY - JOUR
T1 - Outpatient vancomycin use and vancomycin-resistant enterococcal colonization in maintenance dialysis patients
AU - Atta, M. G.
AU - Eustace, J. A.
AU - Song, X.
AU - Perl, T. M.
AU - Scheel, Jr
N1 - Funding Information:
Dr. Atta was supported by a grant from the National Kidney Foundation of Maryland. Dr. Eustace was supported in part by a Johns Hopkins University Clinical Scientist Career Development award. The authors acknowledge the assistance of Pam Babij, CNP; Martha Conlon, RN; Nancy Feeley, CNP; Doreen Kuhn, CNP; and Shelly Malan, RN, BSN, for their help in the conduct of this study. They also thank Sarah Dieter for her secretarial assistance and Professor Joseph Handler and Professor Neil R. Powe for their review of the manuscript.
PY - 2001
Y1 - 2001
N2 - Outpatient vancomycin use and vancomycin-resistant enterococcal colonization in maintenance dialysis patients. Background. Although outpatient vancomycin is widely used as empiric therapy for dialysis-associated infections, its relationship with vancomycin-resistant enterococcal (VRE) colonization is not established. Methods. During a two-year prospective cohort study, rectal swabs obtained from patients at the start and finish of the study period and during interim hospitalizations were cultured for VRE. Results. Ten of 124 patients initially grew VRE. Twenty-four of the remaining patients had no follow-up cultures because of patient death (62%), transfer to another dialysis facility (17%), patient's refusal (7%), and transplantation (4%), and were thus excluded. The remaining patients (N = 90) had a median age of 54.3 years and were 92% African American and 50% male. Fifty-eight percent were treated by hemodialysis. They received 403 g of intravenous vancomycin over 157.2 patient-years of follow-up, 73% as outpatients. Sixteen of 90 patients (17.8%) became colonized with VRE, an incidence rate of one case per 9.8 patient-years of follow-up. None of the 29 patients who did not receive vancomycin developed VRE compared with 26% of those treated with vancomycin (P = 0.001). The odds ratio (95 % CI) for the association of outpatient vancomycin (g per year) with VRE colonization was 1.23 (1.05, 1.44, P = 0.008). The association remained significant following adjustment in separate logistic regression analyses for relevant demographic, clinical, antimicrobial (inpatient vancomycin, oral or intravenous cephalosprins, aminoglycosides, quinalones, or anti-anaerobics), and hospitalization exposures. The unadjusted relative risk of death in patients growing VRE was significantly higher than in those not colonized with VRE (P = 0.005). Conclusions. VRE colonization is a relatively common and underrecognized problem among chronic dialysis patients. It is strongly and independently associated with the outpatient use of vancomycin, which should be avoided whenever possible.
AB - Outpatient vancomycin use and vancomycin-resistant enterococcal colonization in maintenance dialysis patients. Background. Although outpatient vancomycin is widely used as empiric therapy for dialysis-associated infections, its relationship with vancomycin-resistant enterococcal (VRE) colonization is not established. Methods. During a two-year prospective cohort study, rectal swabs obtained from patients at the start and finish of the study period and during interim hospitalizations were cultured for VRE. Results. Ten of 124 patients initially grew VRE. Twenty-four of the remaining patients had no follow-up cultures because of patient death (62%), transfer to another dialysis facility (17%), patient's refusal (7%), and transplantation (4%), and were thus excluded. The remaining patients (N = 90) had a median age of 54.3 years and were 92% African American and 50% male. Fifty-eight percent were treated by hemodialysis. They received 403 g of intravenous vancomycin over 157.2 patient-years of follow-up, 73% as outpatients. Sixteen of 90 patients (17.8%) became colonized with VRE, an incidence rate of one case per 9.8 patient-years of follow-up. None of the 29 patients who did not receive vancomycin developed VRE compared with 26% of those treated with vancomycin (P = 0.001). The odds ratio (95 % CI) for the association of outpatient vancomycin (g per year) with VRE colonization was 1.23 (1.05, 1.44, P = 0.008). The association remained significant following adjustment in separate logistic regression analyses for relevant demographic, clinical, antimicrobial (inpatient vancomycin, oral or intravenous cephalosprins, aminoglycosides, quinalones, or anti-anaerobics), and hospitalization exposures. The unadjusted relative risk of death in patients growing VRE was significantly higher than in those not colonized with VRE (P = 0.005). Conclusions. VRE colonization is a relatively common and underrecognized problem among chronic dialysis patients. It is strongly and independently associated with the outpatient use of vancomycin, which should be avoided whenever possible.
KW - Bacteria
KW - Chronic dialysis
KW - Dialysis-related infection
KW - End-stage renal disease
KW - Gram-positive organisms
KW - Infection
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U2 - 10.1046/j.1523-1755.2001.059002718.x
DO - 10.1046/j.1523-1755.2001.059002718.x
M3 - Article
C2 - 11168954
AN - SCOPUS:0035132624
SN - 0085-2538
VL - 59
SP - 718
EP - 724
JO - Kidney international
JF - Kidney international
IS - 2
ER -