title: Enterococcal bacteremia in the surgical intensive care unit. Does vancomycin resistance affect mortality? The Johns Hopkins SICU Study Group.
abstract: OBJECTIVE
  To determine the incidence and mortality rate associated with nosocomial bacteremia caused by vancomycin-resistant Enterococcus in a surgical intensive care unit.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  The surgical intensive care unit of a large university hospital tertiary referral center.
  
  
  METHODS
  All patients in the surgical intensive care unit with a documented nosocomial bacteremia between January 1, 1992, and December 31, 1994.
  
  
  METHODS
  None.
  
  
  METHODS
  Mortality rate.
  
  
  RESULTS
  Of the 134 nosocomial bacteremic episodes, 30.6% involved enterococci; 24.4% of the enterococci were resistant to vancomycin. Patients with vancomycin-resistant enterococcal bacteremia had a significantly longer hospital stay (mean +/- SD, 28 +/- 18 vs 12 +/- 10 days; P = .005) and were more likely to have been treated with vancomycin (70% vs 10.3%; P = .001) than patients with vancomycin-sensitive enterococcal bacteremia. The mortality (41.0%) associated with enterococcal bacteremia was similar to the overall bacteremic mortality (41.7%). There was no difference in episode-specific mortality associated with vancomycin-resistant enterococci (40%) vs vancomycin-sensitive enterococci (38.7%). Of the 4 deaths associated with vancomycin-resistant enterococcal bacteremia, only 2 occurred within 14 days of the bacteremia, as did 8 of 12 deaths associated with vancomycin-sensitive enterococcal bacteremia (P = .64).
  
  
  CONCLUSIONS
  Enterococci were the most commonly isolated nosocomial blood-borne pathogens in the surgical intensive care unit. Nearly 25% of the enterococcal bacteremic episodes were resistant to vancomycin. Vancomycin-resistant Enterococcus is associated with a prolonged hospital stay and with vancomycin use. Nevertheless, vancomycin resistance itself does not increase the mortality rate associated with enterococcal bacteremia.
authors.affiliation: Department of Surgery, Louisiana State University Medical Center, Shreveport, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Mainous
authors.forename: P A
authors.initials: PA
authors.lastname: Lipsett
authors.forename: M
authors.initials: M
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000401:mortality*; D003428:Cross Infection / Q000188:drug therapy / Q000401:mortality*; D004352:Drug Resistance, Microbial; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011997:Recovery Room; D012189:Retrospective Studies; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin