title: Emergence of vancomycin-resistant Enterococcus bloodstream infections in southern Taiwan.
abstract: BACKGROUND
  An increased incidence of vancomycin-resistant enterococcal bloodstream infections (VRE BSI) in the United States has been noted in recent years. There were a few reports of VRE BSI in Taiwan. This study is intended to show the epidemiology, clinical features and outcomes of VRE BSI at a medical center in southern Taiwan.
  
  
  METHODS
  A retrospective study was conducted from January 1, 2005 to December 31, 2010. All patients with VRE BSI episodes were identified and their medical records were reviewed.
  
  
  RESULTS
  A total of 69 episodes of VRE BSI were identified in the study period. The incidence rate increased from 0.01 episodes of VRE BSI/1000 patient-days in 2005 to 0.07 episodes of VRE BSI/1000 patient-days in 2010. The 30-day mortality rate was 52.17% for all patients with VRE BSI. The mortality rate of patients who received in vitro active and inactive antimicrobial therapy for VRE BSI was 40% and 100%, respectively (p < 0.001). Factors associated with mortality were shock [odds ratio (OR) 24.4, 95% confidence interval (CI) 3.6-163.2, p = 0.001], renal failure (OR 90.9, 95% CI 1.9-4404.3, p = 0.02), and underlying liver cirrhosis (OR 12.4, 95% CI 1.2-125.8, p = 0.03). Use of linezolid for VRE BSI showed a trend for lower 30-day mortality than daptomycin therapy (35.5% vs. 56.3%, p = 0.17).
  
  
  CONCLUSIONS
  VRE BSI is increasingly important in the study hospital and is associated with a significant mortality rate. Appropriateness of antimicrobial therapy has a prognostic impact on patients with VRE BSI.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Chien-Hsuan
authors.initials: CH
authors.lastname: Chou
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.forename: Hsin-Chun
authors.initials: HC
authors.lastname: Lee
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000081:Acetamides / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D017576:Daptomycin / Q000494:pharmacology / Q000627:therapeutic use; D016983:Enterococcus / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000494:pharmacology / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use; D020713:Vancomycin Resistance
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid; D017576:Daptomycin