title: Vancomycin-resistant enterococci bacteremia: risk factors for mortality and influence of antimicrobial therapy on clinical outcome.
abstract: 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.
authors.affiliation: Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Han
authors.forename: Bum Sik
authors.initials: BS
authors.lastname: Chin
authors.forename: Han Sung
authors.initials: HS
authors.lastname: Lee
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Jeong
authors.forename: Hee Kyoung
authors.initials: HK
authors.lastname: Choi
authors.forename: Chang Oh
authors.initials: CO
authors.lastname: Kim
authors.forename: Dongeun
authors.initials: D
authors.lastname: Yong
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
authors.forename: Young Goo
authors.initials: YG
authors.lastname: Song
authors.forename: Kyungwon
authors.initials: K
authors.lastname: Lee
authors.forename: June Myung
authors.initials: JM
authors.lastname: Kim
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents