Alevizakos Michail, Gaitanidis Apostolos, Nasioudis Dimitrios, Tori Katerina, Flokas Myrto Eleni, Mylonakis Eleftherios
Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence.
Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York.
Open Forum Infect Dis. 2016 Dec 7;4(1):ofw246. doi: 10.1093/ofid/ofw246. eCollection 2017 Winter.
Vancomycin-resistant enterococci (VRE) cause severe infections among patients with malignancy, and these infections are usually preceded by gastrointestinal colonization.
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.
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.
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.
耐万古霉素肠球菌（VRE）在恶性肿瘤患者中可引发严重感染，且这些感染通常先有胃肠道定植。
我们检索了PubMed和EMBASE数据库（截至2016年5月26日），以识别报告实体或血液系统恶性肿瘤患者VRE胃肠道定植数据的研究。
我们的分析纳入了34项研究，报告了8391例恶性肿瘤患者的数据。该人群中VRE定植的合并患病率为20%（95%置信区间[CI]，14%-26%）。在血液系统恶性肿瘤患者中，24%（95%CI，16%-34%）有VRE定植，而没有研究仅报告实体恶性肿瘤患者的数据。急性白血病患者VRE定植风险更高（风险比[RR]=1.95；95%CI，1.17-3.26）。3个月内使用万古霉素或住院与定植风险增加相关（RR分别为1.92，95%CI=1.06-3.45和RR=4.68，95%CI=1.66-13.21）。在不同地理区域中，北美VRE定植率为21%（95%CI，13%-31%），欧洲为20%（95%CI，9%-34%），亚洲为23%（95%CI，13%-38%），大洋洲为4%（95%CI，2%-6%）。更重要的是，定植患者发生VRE血流感染的可能性是非定植患者的24.15倍（95%CI，10.27-56.79）。
恶性肿瘤患者中存在相当大的VRE定植负担，定植大大增加了随后发生VRE血流感染的风险。需要坚持抗菌药物管理，可能有必要重新评估该患者群体将万古霉素用作经验性治疗的情况。
