Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
Copyright © 2020 Yeungnam University College of Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
Conceptualization: YK, HHC, KTK, SWK; Data curation: YK, SB, SH, SJK, HKP, JML; Formal analysis: YK, KTK, SWK; Methodology: YK, KTK, SWK; Project administration: YK, HHC, SJK, HKP, JML, SWK; Visualization: YK, KTK, SWK; Writing–original draft: YK; Writing–review & editing: YK, HHC, KTK, SB, SH, SJK, HKP, JML, SWK
Characteristic | Doxycycline treatment (n=21) | Non-treatment (n=62) | Total (n=83) | p-value |
---|---|---|---|---|
Age (yr) | 73 (63–79) | 71.5 (59–79) | 72 (60–79) | 0.814 |
Sex | 0.970 | |||
Male | 5 (23.8) | 17 (27.4) | 22 (26.5) | |
Female | 16 (76.2) | 45 (72.6) | 61 (73.5) | |
Eradication | 0.014 | |||
No | 2 (9.5) | 26 (41.9) | 28 (33.7) | |
Yes | 19 (90.5) | 36 (58.1) | 55 (66.3) | |
VRE recurrence | 0.452 | |||
No | 17 (81.0) | 56 (90.3) | 73 (88.0) | |
Yes | 4 (19.0) | 6 (9.7) | 10 (12.0) | |
Total admission days | 52.0 (25.0–79.0) | 41.5 (24.0–62.0) | 43.0 (24.5–68.0) | 0.274 |
Admission days after VRE detection | 31.0 (19.0–44.0) | 23.5 (12.0–42.0) | 26.0 (14.0–42.0) | 0.175 |
Culture follow-up days after VRE detection | 4 (3–5) | 4 (3–5) | 4 (3–5) | 0.548 |
Species | 0.992 | |||
Enterococcus faecalis | 0 | 2 (3.2) | 2 (2.4) | |
Enterococcus faecium | 21 (100) | 60 (96.8) | 81 (97.6) | |
Tetracycline (MIC) | 0.132 | |||
R (≥16) | 1 (4.8) | 14 (22.6) | 15 (18.1) | |
S (≤2) | 20 (95.2) | 48 (77.4) | 68 (81.9) | |
Tigecycline (MIC) | NA | |||
R (≥4) | 0 | 0 | 0 | |
S (≤0.25) | 21 (100) | 60 (100) | 81 (100) | |
Indwelling catheter at diagnosis | 1.000 | |||
No | 9 (42.9) | 26 (41.9) | 35 (42.2) | |
Yes | 12 (57.1) | 36 (58.1) | 48 (57.8) | |
Urogenital abnormalitya) | 0.207 | |||
No | 17 (81.0) | 58 (93.5) | 75 (90.4) | |
Yes | 4 (19.0) | 4 (6.5) | 8 (9.6) | |
Pyuria | 0.045 | |||
No | 13 (61.9) | 53 (85.5) | 66 (79.5) | |
Yes | 8 (38.1) | 9 (14.5) | 17 (20.5) | |
Dysuria | 0.565 | |||
No | 19 (90.5) | 60 (96.8) | 79 (95.2) | |
Yes | 2 (9.5) | 2 (3.2) | 4 (4.8) | |
Hematologic malignancy | 0.528 | |||
No | 20 (95.2) | 54 (87.1) | 74 (89.2) | |
Yes | 1 (4.8) | 8 (12.9) | 9 (10.8) | |
Solid tumor | 1.000 | |||
No | 18 (85.7) | 55 (88.7) | 73 (88.0) | |
Yes | 3 (14.3) | 7 (11.3) | 10 (12.0) | |
Diabetes mellitus | 0.252 | |||
No | 11 (52.4) | 43 (69.4) | 54 (65.1) | |
Yes | 10 (47.6) | 19 (30.6) | 29 (34.9) | |
Chronic kidney disease (HD, PD) | 0.491 | |||
No | 14 (66.7) | 48 (77.4) | 62 (74.7) | |
Yes | 7 (33.3) | 14 (22.6) | 21 (25.3) | |
Cerebrovascular accident | 1.000 | |||
No | 15 (71.4) | 45 (72.6) | 60 (72.3) | |
Yes | 6 (28.6) | 17 (27.4) | 23 (27.7) | |
Degenerative brain disease | 1.000 | |||
No | 20 (95.2) | 58 (93.5) | 78 (94.0) | |
Yes | 1 (4.8) | 4 (6.5) | 5 (6.0) |
Univariate analysis following doxycycline administration. Values are presented as median (interquartile range), number (%) or mean (range).
VRE, vancomycin-resistant Enterococcus; MIC, minimum inhibitory concentration; R, resistant; S, sensitive; HD, hemodialysis; PD, peritoneal dialysis; NA, not available.
a)Urogenital abnormality group included patients who showed the presence of percutaneous drainage, percutaneous nephrostomy, or double J catheter owing to obstructive hydronephrosis.
Characteristic | Doxycycline treatment (n=21) | Non-treatment (n=62) | Total (n=83) | p-value |
---|---|---|---|---|
Antibiotic use | 0.453 | |||
Yes | 15 (71.4) | 51 (82.3) | 66 (79.5) | |
No | 6 (28.6) | 11 (17.7) | 17 (20.5) | |
Carbapenems | 1.000 | |||
Yes | 5 (23.8) | 16 (25.8) | 21 (25.3) | |
No | 16 (76.2) | 46 (74.2) | 62 (74.7) | |
Glycopeptides | 1.000 | |||
Yes | 2 (9.5) | 7 (11.3) | 9 (10.8) | |
No | 19 (90.5) | 55 (88.7) | 74 (89.2) | |
Piperacillin/tazobactam | 0.120 | |||
Yes | 3 (14.3) | 22 (35.5) | 25 (30.1) | |
No | 18 (85.7) | 40 (64.5) | 58 (69.9) | |
Third-generation cephalosporins | 0.080 | |||
Yes | 1 (4.8) | 16 (25.8) | 17 (20.5) | |
No | 20 (95.2) | 46 (74.2) | 66 (79.5) | |
Fluoroquinolonesa) | 1.000 | |||
Yes | 4 (19.0) | 12 (19.4) | 16 (19.3) | |
No | 17 (81.0) | 50 (80.6) | 67 (80.7) | |
Metronidazole | 1.000 | |||
Yes | 3 (14.3) | 7 (11.3) | 10 (12.0) | |
No | 18 (85.7) | 55 (88.7) | 73 (88.0) | |
Ampicillin/sulbactam | 0.338 | |||
Yes | 3 (14.3) | 3 (4.8) | 6 (7.2) | |
No | 18 (85.7) | 59 (95.2) | 77 (92.8) |
Characteristic | Doxycycline treatment (n=21) | Non-treatment (n=62) | Total (n=83) | p-value |
---|---|---|---|---|
Infection location | 0.726 | |||
Ward | 21 (100) | 59 (95.2) | 80 (96.4) | |
ICU | 0 | 3 (4.8) | 3 (3.6) | |
VRE detection departmenta) | 1.000 | |||
Surgeryb) | 7 (33.3) | 21 (33.9) | 28 (33.7) | |
Non-surgeryc) | 14 (66.7) | 41 (66.1) | 55 (66.3) | |
In-hospital mortality | 1.000 | |||
No | 19 (90.5) | 56 (91.9) | 75 (90.4) | |
Yes | 2 (9.5) | 6 (9.7) | 8 (9.6) | |
Mortality within 6 months after urine VRE detection | 1.000 | |||
No | 17 (81.0) | 52 (83.9) | 69 (83.1) | |
Yes | 4 (19.0) | 10 (16.1) | 14 (16.9) | |
Mortality due to VRE infection | NA | |||
No | 21 (100) | 62 (100) | 83 (100) | |
Yes | 0 | 0 | 0 | |
VRE bacteremia | 1.000 | |||
Yes | 0 | 1 (1.6) | 1 (1.2) | |
No | 21 (100) | 61 (98.4) | 82 (98.8) | |
Bacteremiad) during admission | 0.191 | |||
Yes | 3 (14.3) | 20 (32.3) | 23 (27.7) | |
No | 18 (85.7) | 42 (67.7) | 60 (72.3) | |
Bacteremiad) identified after urine VRE detection | 0.361 | |||
Yes | 1 (4.8) | 6 (9.7) | 7 (8.4) | |
No | 20 (95.2) | 52 (83.9) | 72 (86.7) | |
Same time | 0 | 4 (6.5) | 4 (4.8) |
Values are presented as number (%).
VRE, vancomycin-resistant Enterococcus; ICU, intensive care unit.
a)Supplementary Table 1.
b)Surgery departments include colorectal surgery, urology, plastic surgery, neurosurgery, general surgery, breast and thyroid surgery, and vascular surgery departments.
c)Non-surgery departments include endocrinology, rheumatology, gastroenterology, cardiology, nephrology, infection, emergency, rehabilitation, and neurology departments.
d)Bacteremia regardless of bacterial species, including VRE.
Risk factor | Urine VRE colonization (n=83) | |||
---|---|---|---|---|
Univariate OR | Multivariate OR | |||
95% CI | p-value | 95% CI | p-value | |
Age (>80 yr) | 2.42 (0.83–7.15) | 0.105 | 2.42 (0.74–8.25) | 0.1463 |
Doxycycline non-treatment | 6.86 (1.78–45.45) | 0.014 | 6.04 (1.46–41.99) | 0.0279 |
Presence of pyuria | 0.54 (0.14–1.72) | 0.323 | - | - |
Presence of indwelling catheter (Foley catheter) | 0.77 (0.31–1.94) | 0.575 | - | - |
Presence of PCD, PCN, or double J catheter | 0.25 (0.01–1.54) | 0.211 | - | - |
Bacteremiaa) during admission period | 0.94 (0.35–2.67) | 0.901 | - | - |
Solid tumor | 2.17 (0.56–8.55) | 0.254 | 2.46 (0.53–12.25) | 0.2496 |
Hematologic malignancy | 1.67 (0.38–6.86) | 0.475 | 1.76 (0.36–8.31) | 0.4692 |
Diabetes mellitus | 0.83 (0.31–2.15) | 0.703 | - | - |
Chronic kidney disease (HD, PD) | 0.77 (0.28–2.17) | 0.625 | - | - |
Cerebrovascular accident | 0.81 (0.28–2.23) | 0.694 | - | - |
VRE, vancomycin-resistant Enterococcus; OR, odds ratio; CI, confidence interval; PCD, percutaneous drainage catheter; PCN, percutaneous nephrostomy catheter; HD, hemodialysis; PD, peritoneal dialysis.
a)Bacteremia regardless of bacterial species, including VRE. Results from the finally selected model were presented in multivariate OR column.
Characteristic | Doxycycline treatment (n=21) | Non-treatment (n=62) | Total (n=83) | p-value |
---|---|---|---|---|
Age (yr) | 73 (63–79) | 71.5 (59–79) | 72 (60–79) | 0.814 |
Sex | 0.970 | |||
Male | 5 (23.8) | 17 (27.4) | 22 (26.5) | |
Female | 16 (76.2) | 45 (72.6) | 61 (73.5) | |
Eradication | 0.014 | |||
No | 2 (9.5) | 26 (41.9) | 28 (33.7) | |
Yes | 19 (90.5) | 36 (58.1) | 55 (66.3) | |
VRE recurrence | 0.452 | |||
No | 17 (81.0) | 56 (90.3) | 73 (88.0) | |
Yes | 4 (19.0) | 6 (9.7) | 10 (12.0) | |
Total admission days | 52.0 (25.0–79.0) | 41.5 (24.0–62.0) | 43.0 (24.5–68.0) | 0.274 |
Admission days after VRE detection | 31.0 (19.0–44.0) | 23.5 (12.0–42.0) | 26.0 (14.0–42.0) | 0.175 |
Culture follow-up days after VRE detection | 4 (3–5) | 4 (3–5) | 4 (3–5) | 0.548 |
Species | 0.992 | |||
Enterococcus faecalis | 0 | 2 (3.2) | 2 (2.4) | |
Enterococcus faecium | 21 (100) | 60 (96.8) | 81 (97.6) | |
Tetracycline (MIC) | 0.132 | |||
R (≥16) | 1 (4.8) | 14 (22.6) | 15 (18.1) | |
S (≤2) | 20 (95.2) | 48 (77.4) | 68 (81.9) | |
Tigecycline (MIC) | NA | |||
R (≥4) | 0 | 0 | 0 | |
S (≤0.25) | 21 (100) | 60 (100) | 81 (100) | |
Indwelling catheter at diagnosis | 1.000 | |||
No | 9 (42.9) | 26 (41.9) | 35 (42.2) | |
Yes | 12 (57.1) | 36 (58.1) | 48 (57.8) | |
Urogenital abnormality |
0.207 | |||
No | 17 (81.0) | 58 (93.5) | 75 (90.4) | |
Yes | 4 (19.0) | 4 (6.5) | 8 (9.6) | |
Pyuria | 0.045 | |||
No | 13 (61.9) | 53 (85.5) | 66 (79.5) | |
Yes | 8 (38.1) | 9 (14.5) | 17 (20.5) | |
Dysuria | 0.565 | |||
No | 19 (90.5) | 60 (96.8) | 79 (95.2) | |
Yes | 2 (9.5) | 2 (3.2) | 4 (4.8) | |
Hematologic malignancy | 0.528 | |||
No | 20 (95.2) | 54 (87.1) | 74 (89.2) | |
Yes | 1 (4.8) | 8 (12.9) | 9 (10.8) | |
Solid tumor | 1.000 | |||
No | 18 (85.7) | 55 (88.7) | 73 (88.0) | |
Yes | 3 (14.3) | 7 (11.3) | 10 (12.0) | |
Diabetes mellitus | 0.252 | |||
No | 11 (52.4) | 43 (69.4) | 54 (65.1) | |
Yes | 10 (47.6) | 19 (30.6) | 29 (34.9) | |
Chronic kidney disease (HD, PD) | 0.491 | |||
No | 14 (66.7) | 48 (77.4) | 62 (74.7) | |
Yes | 7 (33.3) | 14 (22.6) | 21 (25.3) | |
Cerebrovascular accident | 1.000 | |||
No | 15 (71.4) | 45 (72.6) | 60 (72.3) | |
Yes | 6 (28.6) | 17 (27.4) | 23 (27.7) | |
Degenerative brain disease | 1.000 | |||
No | 20 (95.2) | 58 (93.5) | 78 (94.0) | |
Yes | 1 (4.8) | 4 (6.5) | 5 (6.0) |
Characteristic | Doxycycline treatment (n=21) | Non-treatment (n=62) | Total (n=83) | p-value |
---|---|---|---|---|
Antibiotic use | 0.453 | |||
Yes | 15 (71.4) | 51 (82.3) | 66 (79.5) | |
No | 6 (28.6) | 11 (17.7) | 17 (20.5) | |
Carbapenems | 1.000 | |||
Yes | 5 (23.8) | 16 (25.8) | 21 (25.3) | |
No | 16 (76.2) | 46 (74.2) | 62 (74.7) | |
Glycopeptides | 1.000 | |||
Yes | 2 (9.5) | 7 (11.3) | 9 (10.8) | |
No | 19 (90.5) | 55 (88.7) | 74 (89.2) | |
Piperacillin/tazobactam | 0.120 | |||
Yes | 3 (14.3) | 22 (35.5) | 25 (30.1) | |
No | 18 (85.7) | 40 (64.5) | 58 (69.9) | |
Third-generation cephalosporins | 0.080 | |||
Yes | 1 (4.8) | 16 (25.8) | 17 (20.5) | |
No | 20 (95.2) | 46 (74.2) | 66 (79.5) | |
Fluoroquinolones |
1.000 | |||
Yes | 4 (19.0) | 12 (19.4) | 16 (19.3) | |
No | 17 (81.0) | 50 (80.6) | 67 (80.7) | |
Metronidazole | 1.000 | |||
Yes | 3 (14.3) | 7 (11.3) | 10 (12.0) | |
No | 18 (85.7) | 55 (88.7) | 73 (88.0) | |
Ampicillin/sulbactam | 0.338 | |||
Yes | 3 (14.3) | 3 (4.8) | 6 (7.2) | |
No | 18 (85.7) | 59 (95.2) | 77 (92.8) |
Characteristic | Doxycycline treatment (n=21) | Non-treatment (n=62) | Total (n=83) | p-value |
---|---|---|---|---|
Infection location | 0.726 | |||
Ward | 21 (100) | 59 (95.2) | 80 (96.4) | |
ICU | 0 | 3 (4.8) | 3 (3.6) | |
VRE detection department |
1.000 | |||
Surgery |
7 (33.3) | 21 (33.9) | 28 (33.7) | |
Non-surgery |
14 (66.7) | 41 (66.1) | 55 (66.3) | |
In-hospital mortality | 1.000 | |||
No | 19 (90.5) | 56 (91.9) | 75 (90.4) | |
Yes | 2 (9.5) | 6 (9.7) | 8 (9.6) | |
Mortality within 6 months after urine VRE detection | 1.000 | |||
No | 17 (81.0) | 52 (83.9) | 69 (83.1) | |
Yes | 4 (19.0) | 10 (16.1) | 14 (16.9) | |
Mortality due to VRE infection | NA | |||
No | 21 (100) | 62 (100) | 83 (100) | |
Yes | 0 | 0 | 0 | |
VRE bacteremia | 1.000 | |||
Yes | 0 | 1 (1.6) | 1 (1.2) | |
No | 21 (100) | 61 (98.4) | 82 (98.8) | |
Bacteremia |
0.191 | |||
Yes | 3 (14.3) | 20 (32.3) | 23 (27.7) | |
No | 18 (85.7) | 42 (67.7) | 60 (72.3) | |
Bacteremia |
0.361 | |||
Yes | 1 (4.8) | 6 (9.7) | 7 (8.4) | |
No | 20 (95.2) | 52 (83.9) | 72 (86.7) | |
Same time | 0 | 4 (6.5) | 4 (4.8) |
Risk factor | Urine VRE colonization (n=83) | |||
---|---|---|---|---|
Univariate OR | Multivariate OR | |||
95% CI | p-value | 95% CI | p-value | |
Age (>80 yr) | 2.42 (0.83–7.15) | 0.105 | 2.42 (0.74–8.25) | 0.1463 |
Doxycycline non-treatment | 6.86 (1.78–45.45) | 0.014 | 6.04 (1.46–41.99) | 0.0279 |
Presence of pyuria | 0.54 (0.14–1.72) | 0.323 | - | - |
Presence of indwelling catheter (Foley catheter) | 0.77 (0.31–1.94) | 0.575 | - | - |
Presence of PCD, PCN, or double J catheter | 0.25 (0.01–1.54) | 0.211 | - | - |
Bacteremia |
0.94 (0.35–2.67) | 0.901 | - | - |
Solid tumor | 2.17 (0.56–8.55) | 0.254 | 2.46 (0.53–12.25) | 0.2496 |
Hematologic malignancy | 1.67 (0.38–6.86) | 0.475 | 1.76 (0.36–8.31) | 0.4692 |
Diabetes mellitus | 0.83 (0.31–2.15) | 0.703 | - | - |
Chronic kidney disease (HD, PD) | 0.77 (0.28–2.17) | 0.625 | - | - |
Cerebrovascular accident | 0.81 (0.28–2.23) | 0.694 | - | - |
Univariate analysis following doxycycline administration. Values are presented as median (interquartile range), number (%) or mean (range). VRE, vancomycin-resistant Urogenital abnormality group included patients who showed the presence of percutaneous drainage, percutaneous nephrostomy, or double J catheter owing to obstructive hydronephrosis.
Values are presented as number (%). Fluoroquinolones include ciprofloxacin and levofloxacin.
Values are presented as number (%). VRE, vancomycin-resistant Supplementary Table 1. Surgery departments include colorectal surgery, urology, plastic surgery, neurosurgery, general surgery, breast and thyroid surgery, and vascular surgery departments. Non-surgery departments include endocrinology, rheumatology, gastroenterology, cardiology, nephrology, infection, emergency, rehabilitation, and neurology departments. Bacteremia regardless of bacterial species, including VRE.
VRE, vancomycin-resistant Bacteremia regardless of bacterial species, including VRE. Results from the finally selected model were presented in multivariate OR column.