title: Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality.
abstract: Previous studies have shown that bacteremia due to vancomycin-resistant Enterococcus species (VRE) is associated with mortality of 17%-100%, but comorbid conditions may have confounded the estimates. We designed a historical cohort study to determine the mortality attributable to VRE bacteremia. Twenty-seven patients with VRE bacteremia were identified as cases. Within 7 days of the onset of bacteremia, severe sepsis developed in 12 patients (44%) and septic shock developed in 10 (37%). Case patients were closely matched to control patients without VRE bacteremia (1:1) by time of hospitalization, duration of exposure, underlying disease, age, gender, and surgical procedure. The mortality was 67% among cases and 30% among matched controls (P = 0.1). Thus, the mortality attributable to VRE bacteremia was 37% (95% confidence interval [CI], 10%-64%) and the risk ratio for death was 2.3 [CI, 1.2-4.1). We conclude that VRE bacteremia is associated with high rates of severe sepsis and septic shock. The attributable mortality approaches 40%, and patients who have VRE bacteremia are twice as likely to die than closely matched controls.
authors.affiliation: Division of Quality Health Care, Medical College of Virginia Commonwealth University, Richmond 23298-0509, USA. MEDMOND@Gems.VCU.EDU
authors.forename: M B
authors.initials: MB
authors.lastname: Edmond
authors.forename: J F
authors.initials: JF
authors.lastname: Ober
authors.forename: J D
authors.initials: JD
authors.lastname: Dawson
authors.forename: D L
authors.initials: DL
authors.lastname: Weinbaum
authors.forename: R P
authors.initials: RP
authors.lastname: Wenzel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000401:mortality; D012772:Shock, Septic / Q000401:mortality; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D014640:Vancomycin