title: Enterococcal bacteremia: risk factors for vancomycin resistance and predictors of mortality.
abstract: OBJECTIVE
  To identify risk factors for vancomycin resistance and mortality in enterococcal bacteremia.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  A large academic medical center with a high prevalence of vancomycin-resistant enterococci (VRE).
  
  
  METHODS
  Two hundred sixty patients with enterococcal bacteremia, of whom 72 (28%) had VRE.
  
  
  RESULTS
  Independent risk factors for infection with VRE were the mean number of antibiotic days (P<.001), renal insufficiency (P<.001), mean days of vancomycin use (P = .005), and neutropenia (P = .013). A trend toward a significant association between metronidazole use and VRE also was noted (P = .068). Mortality was attributable to the bacteremia in 96 patients (37%). Severity of illness (P<.001) and age (P = .020) were independent risk factors for mortality. Vancomycin resistance was not, however, an independent predictor of mortality.
  
  
  CONCLUSIONS
  These results suggest that restrictions on antibiotic use, particularly in patients with renal insufficiency and neutropenia, may help to combat the rising incidence of VRE. Although patients with VRE bacteremia demonstrated higher mortality rates than patients with infection due to susceptible isolates, vancomycin resistance was not an independent predictor of mortality in these patients and likely serves more as a marker of underlying severity of illness.
authors.affiliation: Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
authors.forename: E
authors.initials: E
authors.lastname: Lautenbach
authors.forename: W B
authors.initials: WB
authors.lastname: Bilker
authors.forename: P J
authors.initials: PJ
authors.lastname: Brennan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology*; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D014640:Vancomycin / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin