Decrease in vancomycin-resistant Enterococcus colonization associated with a reduction in carbapenem use as empiric...

Area of Science:

• Infectious Diseases
• Hematology
• Microbiology

Background:

• Vancomycin-resistant Enterococcus (VRE) poses a significant threat in immunocompromised patients, particularly those with acute leukemia.
• Empiric antibiotic selection is crucial for managing neutropenic fever in these high-risk individuals.

Purpose of the Study:

• To compare the impact of empiric carbapenems versus a cycling regimen of cefepime and piperacillin/tazobactam on VRE colonization and bloodstream infections (BSIs) in acute leukemia patients.
• To evaluate the effects of these antibiotic strategies on patient outcomes, including length of stay and hospital costs.

Main Methods:

• Retrospective clinical study involving 342 patients with newly diagnosed acute leukemia.
• Antibiotic regimens were analyzed before and after a change from carbapenems to cycling cefepime/piperacillin-tazobactam for neutropenic fever.
• VRE stool colonization surveillance, VRE molecular strain typing, and gastrointestinal microbiome analysis were performed.

Main Results:

• The shift to cycling antibiotics significantly decreased VRE colonization rates (HR 0.35).
• A switch in dominant VRE MLST types and modifications in the gastrointestinal microbiome were observed.
• No significant differences in gram-positive or gram-negative BSIs were noted, though trends suggested more Candida spp. and fewer ESBL BSIs with carbapenems.

Conclusions:

• Carbapenem-sparing antibiotic regimens may offer advantages in managing VRE ecology and gastrointestinal dysbiosis.
• These strategies may also lead to reduced duration of neutropenia, shorter lengths of stay, and lower hospital costs.