title: Microbiological and clinical characteristics of vancomycin-resistant Enterococcus faecium bacteraemia in Taiwan: implication of sequence type for prognosis.
abstract: OBJECTIVE
  Vancomycin-resistant enterococci (VRE), particularly vancomycin-resistant Enterococcus faecium (VREfm), have emerged among the leading pathogens causing hospital-acquired infections worldwide. We aimed to examine whether there were newly introduced clones contributing to this increase and to assess the risk factors for mortality in patients with VREfm bacteraemia.
  
  
  METHODS
  Between 2003 and 2010, all medical records of adult patients diagnosed with VREfm bacteraemia at a university hospital in Taiwan were reviewed. Antibiotic susceptibility, genotyping and multilocus sequence typing of the VREfm isolates were performed.
  
  
  RESULTS
  During the study period, the prevalence of non-duplicated blood VRE isolates increased significantly from 3.9% in 2003 to 18.9% in 2010 (P < 0.0001). One-hundred-and-forty-nine patients with VREfm bacteraemia were noted and 102 isolates of VREfm were available for microbiological characterization. All isolates were susceptible to daptomycin and linezolid. Sequence type (ST) 18 and ST414 were the two predominant emerging STs from 2009 to 2010, accounting for 29.7% and 25.0% of all isolates, respectively. Patients who received immunosuppressives, had a high Charlson comorbidity index or experienced septic shock had a significantly higher 14 day mortality rate. Patients who had bacteraemia caused by ST414 isolates and received appropriate antibiotics had a lower 14 day mortality rate.
  
  
  CONCLUSIONS
  The prevalence of the VRE that caused bacteraemia increased from 2003 to 2010. This increase might be attributed to the clonal spread of VREfm belonging to ST18 and ST414. The all-cause 14 day mortality rate was lower in patients with bacteraemia due to VREfm isolates that belonged to ST414.
authors.affiliation: Department of Internal Medicine,  National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu,  Taiwan.
authors.forename: Ching-Lan
authors.initials: CL
authors.lastname: Lu
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Chuang
authors.forename: Hao-Chun
authors.initials: HC
authors.lastname: Chang
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D016000:Cluster Analysis; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D016984:Enterococcus faecium / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D005260:Female; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D020713:Vancomycin Resistance