title: Clinical outcomes for patients with bacteremia caused by vancomycin-resistant enterococcus in a level 1 trauma center.
abstract: To assess the degree of morbidity and mortality attributable to vancomycin resistance in enterococcal bacteremia (EB), a matched case-control study was conducted. Patients with bacteremia due to vancomycin-resistant enterococcus (VRE) were matched to control patients with bacteremia due to vancomycin-susceptible enterococcus. During 1996--2000, 65 patients with cases of clinically significant VRE bacteremia were identified, and 53 of these patients were successfully matched. In this group of patients, VRE bacteremia was found to be an independent predictor of crude mortality (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.2--13.3) and the infection-related mortality rate (OR, 5.2; 95% CI, 1.4--20.0). It was also an independent predictor of the rate of clinical failure at day 7 after the onset of EB (OR, 4.6; 95% CI, 1.2--17.3) and overall clinical failure (OR, 4.3; 95% CI, 1.3--14.5) and was associated with a longer mean length of hospitalization after the onset of EB, compared with that for control patients (22.7plus minus1.88 vs. 15.9 +/- 1.7, P=.006). These observations indicate that vancomycin resistance in EB independently affects outcomes.
authors.affiliation: Anti-Infective Research Laboratory, Detroit Receiving Hospital, Wayne State University, Detroit, MI, 48201, USA.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Lodise
authors.forename: Peggy S
authors.initials: PS
authors.lastname: McKinnon
authors.forename: Vincent H
authors.initials: VH
authors.lastname: Tam
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rybak
mesh_terms: D000704:Analysis of Variance; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D016983:Enterococcus; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D014193:Trauma Centers; D020713:Vancomycin Resistance