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. 2016 Dec 7;4(1):ofw246.
doi: 10.1093/ofid/ofw246. eCollection 2017 Winter.

Colonization With Vancomycin-Resistant Enterococci and Risk for Bloodstream Infection Among Patients With Malignancy: A Systematic Review and Meta-Analysis

Michail Alevizakos  1 , Apostolos Gaitanidis  1 , Dimitrios Nasioudis  2 , Katerina Tori  1 , Myrto Eleni Flokas  1 , Eleftherios Mylonakis  1
Affiliations

Colonization With Vancomycin-Resistant Enterococci and Risk for Bloodstream Infection Among Patients With Malignancy: A Systematic Review and Meta-Analysis

Michail Alevizakos et al. Open Forum Infect Dis. .

Abstract

Background: Vancomycin-resistant enterococci (VRE) cause severe infections among patients with malignancy, and these infections are usually preceded by gastrointestinal colonization.

Methods: We searched the PubMed and EMBASE databases (up to May 26, 2016) to identify studies that reported data on VRE gastrointestinal colonization among patients with solid or hematologic malignancy.

Results: Thirty-four studies, reporting data on 8391 patients with malignancy, were included in our analysis. The pooled prevalence of VRE colonization in this population was 20% (95% confidence interval [CI], 14%-26%). Among patients with hematologic malignancy, 24% (95% CI, 16%-34%) were colonized with VRE, whereas no studies reported data solely on patients with solid malignancy. Patients with acute leukemia were at higher risk for VRE colonization (risk ratio [RR] = 1.95; 95% CI, 1.17-3.26). Vancomycin use or hospitalization within 3 months were associated with increased colonization risk (RR = 1.92, 95% CI = 1.06-3.45 and RR = 4.68, 95% CI = 1.66-13.21, respectively). Among the different geographic regions, VRE colonization rate was 21% in North America (95% CI, 13%-31%), 20% in Europe (95% CI, 9%-34%), 23% in Asia (95% CI, 13%-38%), and 4% in Oceania (95% CI, 2%-6%). More importantly, colonized patients were 24.15 (95% CI, 10.27-56.79) times more likely to develop a bloodstream infection due to VRE than noncolonized patients.

Conclusions: A substantial VRE colonization burden exists among patients with malignancy, and colonization greatly increases the risk for subsequent VRE bloodstream infection. Adherence to antimicrobial stewardship is needed, and a re-evaluation of the use of vancomycin as empiric therapy in this patient population may be warranted.

Keywords: VRE.; bloodstream infection; cancer; colonization; malignancy.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram. VRE, vancomycin-resistant enterococci.
Figure 2.
Figure 2.
Forest plot of included studies. Prevalence of vancomycin-resistant enterococci (VRE) colonization among patients with malignancy, stratified by continent. CI, confidence interval; ES, estimated prevalence.
Figure 3.
Figure 3.
Forest plot of included studies. Relative risk (RR) estimates of bloodstream infection with vancomycin-resistant enterococci among colonized and noncolonized patients. CI, confidence interval; ID, identification.
See this image and copyright information in PMC

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