title: Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections.
abstract: Risk factors for vancomycin-resistant enterococcal (VRE) bloodstream infection (BSI) were studied at a tertiary-care hospital by comparing 46 patients with VRE-BSI with 46 randomly selected patients with vancomycin-susceptible enterococcal (VSE) BSI. Among patients with an enterococcal BSI, risk factors for mortality were determined. Independent risk factors for VRE-BSI were increasing APACHE II score (odds ratio [OR], 2.3/5-point increase; 95% confidence interval [CI], 1.4-3.9), receipt of vancomycin (OR, 11; 95% CI, 5.5-21), or diagnosis of hematologic malignancy (OR, 8.4; 95% CI, 3.9-18). After controlling for APACHE II score and gender, patients with VRE- versus VSE-BSI did not have a significantly elevated risk of mortality (OR, 3.3; 95% CI, 0.7-15). Five of 28 VRE blood isolates typed using pulsed-field gel electrophoresis had identical banding patterns. These data suggest that increasing severity of illness, underlying disease, and receipt of vancomycin are major risk factors for VRE-BSI.
authors.affiliation: Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Shay
authors.forename: S A
authors.initials: SA
authors.lastname: Maloney
authors.forename: M
authors.initials: M
authors.lastname: Montecalvo
authors.forename: S
authors.initials: S
authors.lastname: Banerjee
authors.forename: G P
authors.initials: GP
authors.lastname: Wormser
authors.forename: M J
authors.initials: MJ
authors.lastname: Arduino
authors.forename: L A
authors.initials: LA
authors.lastname: Bland
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D018806:APACHE; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000145:classification / Q000472:pathogenicity*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007297:Inpatients; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D010349:Patient Compliance; D010356:Patient Isolation; D012044:Regression Analysis; D013997:Time Factors; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin