Vancomycin-resistant enterococci bacteremia: risk factors for mortality and influence of antimicrobial therapy on clinical outcome.
OBJECTIVE
This study evaluated the effects of antimicrobial treatment against vancomycin-resistant enterococci (VRE) and delayed administration of anti-VRE therapy on mortality, and determined independent risk factors for delayed all-cause mortality of VRE bacteremia patients.


METHODS
Over 10 years, 153 patients with clinically significant monomicrobial VRE bacteremia were identified among a total of 2834 patients in a VRE cohort. The main outcomes were immediate (7-day) and delayed (28-day, 60-day) all-cause mortality.


RESULTS
The 7-day (P<0.001) and 28-day (P=0.041) mortalities were lower in the group receiving anti-VRE therapy, but the 60-day mortality (P=0.113) was unaffected. The mortalities of patients receiving anti-VRE therapy later than 72h after the onset of bacteremia were no different from that of patients receiving treatment within 72h. Both a higher APACHE II score (hazard ratio [HR], 1.10; P<0.001 and HR, 1.12; P<0.001, respectively) and the presence of septic shock at the onset of bacteremia (HR, 1.91; P=0.047 and HR, 1.78; P=0.034, respectively) were independent risk factors for 28-day and 60-day mortality.


CONCLUSIONS
These findings suggest that in spite of antibiotic therapy against VRE, patients with VRE bacteremia eventually have a higher risk of death because of severe illness at the onset of bacteremia.
Han
Sang Hoon
SH
Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Chin
Bum Sik
BS
Lee
Han Sung
HS
Jeong
Su Jin
SJ
Choi
Hee Kyoung
HK
Kim
Chang Oh
CO
Yong
Dongeun
D
Choi
Jun Yong
JY
Song
Young Goo
YG
Lee
Kyungwon
K
Kim
June Myung
JM
D018806:APACHE; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012772:Shock, Septic; D013997:Time Factors; D016896:Treatment Outcome; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents