title: Comparison of the clinical characteristics and outcomes associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant E. faecium bacteremia.
abstract: In published studies, cohorts of patients with bacteremia due to vancomycin-resistant Enterococcus (VRE) have predominantly been infected with Enterococcus faecium. Little is known about the epidemiology and outcomes associated with bacteremia due to VR Enterococcus faecalis. A retrospective study of isolates obtained from January 2008 to October 2010 was conducted at Detroit Medical Center (DMC). Unique patients with blood cultures positive for VRE were reviewed. Outcomes were analyzed using logistic regression. During the study period, 105 cases of bacteremia due to VR E. faecalis and 197 cases of bacteremia due to VR E. faecium were identified. The mean age in the study cohort was 61.5 ± 15 years; 162 subjects (53.6%) were male. After controlling for a propensity score, bacteremia due to VR E. faecalis was associated with >2-fold-lower in-hospital mortality than bacteremia due to VR E. faecium. Interestingly, bacteremia due to VR E. faecalis was associated with longer hospital stay after VRE isolation, although total length of stay was similar for groups with VR E. faecalis and VR E. faecium. Bacteremia due to VR E. faecalis was associated with a >2-fold-lower risk for mortality than bacteremia due to VR E. faecium, possibly due to the availability of β-lactam therapeutics for treatment of VR E. faecalis.
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA. khayakaw@med.wayne.edu
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authors.forename: Namita
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authors.forename: Harikrishna
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authors.forename: Asma
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authors.lastname: Bheemreddy
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authors.forename: Dae-Won
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authors.lastname: Lee
authors.forename: Srinivasa
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authors.lastname: Kamatam
authors.forename: Pradeep
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authors.lastname: Bathina
authors.forename: Priyanka
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authors.lastname: Chalana
authors.forename: Satyam
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authors.lastname: Patel
authors.forename: Sarwan
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authors.lastname: Kumar
authors.forename: Amit
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authors.lastname: Vahia
authors.forename: Kimberly
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authors.forename: Victoria
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authors.lastname: Yee
authors.forename: Jessie
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authors.lastname: Swan
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
authors.forename: Paul R
authors.initials: PR
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authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D013293:Enterococcus faecalis / Q000302:isolation & purification / Q000472:pathogenicity*; D016984:Enterococcus faecium / Q000302:isolation & purification / Q000472:pathogenicity*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014640:Vancomycin / Q000008:administration & dosage* / Q000627:therapeutic use; D020713:Vancomycin Resistance; D047090:beta-Lactams / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D014640:Vancomycin