title: Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents.
abstract: Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSI) are a growing problem with few clinical trials to guide therapy. We conducted a retrospective study of management and predictors of mortality for VRE-BSI at a tertiary-care centre from January 2005 to August 2008. Univariate and multivariable analyses examined the relationship of patient characteristics and antibiotic therapy with 30-day all-cause mortality. Rates of VRE-BSI increased from 0·06 to 0·17 infections/1000 patient-days (P=0·03). For 235 patients, 30-day mortality was 34·9%. Patients were primarily treated with linezolid (44·2%) or daptomycin (36·5%). Factors associated with mortality were haemodialysis [odds ratio (OR) 3·2, 95% confidence interval (CI) 1·6-6·3, P=0·007], mechanical ventilation (OR 3·7, 95% CI 1·3-10·4, P=0·01), and malnutrition (OR 2·0, 95% CI 1·0-4·0, P=0·046). Use of linezolid, but not daptomycin (P=0·052) showed a trend towards an association with survival. In conclusion, VRE-BSI is a growing problem, associated with significant 30-day mortality. Multiple factors were associated with poor outcomes at our hospital.
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Division of Infectious Diseases, Torrance, CA 90502, USA. Dr.McKinnell@yahoo.com
authors.forename: J A
authors.initials: JA
authors.lastname: McKinnell
authors.forename: M
authors.initials: M
authors.lastname: Patel
authors.forename: R M
authors.initials: RM
authors.lastname: Shirley
authors.forename: D F
authors.initials: DF
authors.lastname: Kunz
authors.forename: S A
authors.initials: SA
authors.lastname: Moser
authors.forename: J W
authors.initials: JW
authors.lastname: Baddley
mesh_terms: D000081:Acetamides / Q000627:therapeutic use; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D017576:Daptomycin / Q000627:therapeutic use; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000627:therapeutic use; D012189:Retrospective Studies; D020713:Vancomycin Resistance
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D000069349:Linezolid; D017576:Daptomycin