title: Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection.
abstract: We performed a retrospective cohort study to measure the impact of vancomycin resistance on clinical outcome for 83 episodes of enterococcal bloodstream infection (BSI; 22 with vancomycin-resistant enterococci [VRE] and 61 with vancomycin-susceptible enterococci [VSE]) in 77 patients with neutropenia. Cox proportional hazards models showed that vancomycin resistance was an independent predictor of mortality, after controlling for severity of illness, enterococcal species, gram-negative copathogens, sex, race, duration of neutropenia before bacteremia, and early administration of active antibiotics. This effect was evident only > or =10 days after the onset of bacteremia (P=.0263; hazard ratio [HR], 4.969) but not after adjustment for duration of bacteremia. The median duration of bacteremia was 4.5 days for VRE BSI and <1 day for VSE BSI (P=.0001). The only independent predictor of bacteremia duration was vancomycin resistance (P=.0284; HR, 3.863). Vancomycin resistance is associated with increased mortality in patients with neutropenia, possibly because of prolonged duration of bacteremia.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia 30333, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: DiazGranados
authors.forename: John A
authors.initials: JA
authors.lastname: Jernigan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D016983:Enterococcus / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D020713:Vancomycin Resistance