title: Impact of vancomycin resistance on mortality in neutropenic patients with enterococcal bloodstream infection: a retrospective study.
abstract: BACKGROUND
  Vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) is generally associated with the delayed administration of adequate antibiotics. The identification of risk factors and outcomes of VRE BSI is necessary for establishing strategies for managing neutropenic fever in patients with hematological malignancies.
  
  
  METHODS
  We retrospectively analysed consecutive cases of enterococcal BSI in patients with neutropenia after chemotherapy or stem cell transplantation between July 2009 and December 2011 at a single center.
  
  
  RESULTS
  During the 30-month period, among 1,587 neutropenic patients, the incidence rate of enterococcal BSI was 1.76 cases per 1,000 person-days. Of the 91 enterococcal BSIs, there were 24 cases of VRE. VRE BSI was associated with E. faecium infection (P < .001), prolonged hospitalization (P = .025) and delayed administration (≥ 48 hours after the febrile episode) of adequate antibiotics (P = .002). The attributable mortality was 17% and 9% for VRE and vancomycin-susceptible Enterococcus (VSE), respectively (P = .447). The 30-day crude mortality was 27% and 23% for VRE and VSE, respectively (OR 1.38, 95% CI 0.53-3.59; P = .059). Only SAPS-II was an independent predictive factor for death (adjusted OR 1.12, 95% CI 1.08-1.17; P < .001).
  
  
  CONCLUSIONS
  In conclusion, vancomycin resistance showed some trend towards increasing 30-day mortality, but is not statistically significant despite the delayed use of adequate antibiotics (≥48 hours). Only underlying severity of medical condition predicts poor outcome in a relatively homogeneous group of neutropenic patients.
authors.forename: Sung-Yeon
authors.initials: SY
authors.lastname: Cho
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. symonlee@catholic.ac.kr.
authors.forename: Dong-Gun
authors.initials: DG
authors.lastname: Lee
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Choi
authors.forename: Jae-Cheol
authors.initials: JC
authors.lastname: Kwon
authors.forename: Si-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Jae-Ki
authors.initials: JK
authors.lastname: Choi
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Park
authors.forename: Yeon-Joon
authors.initials: YJ
authors.lastname: Park
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Yoo
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000097:blood / Q000382:microbiology* / Q000401:mortality; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000382:microbiology* / Q000401:mortality; D019337:Hematologic Neoplasms / Q000382:microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood / Q000382:microbiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D014640:Vancomycin / Q000494:pharmacology; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin