title: Glycopeptide use is associated with increased mortality in Enterococcus faecalis bacteraemia.
abstract: OBJECTIVE
  Enterococci are an important cause of nosocomial and community-acquired infections, with bacteraemia being one of the most common presentations. Although inappropriate antimicrobial therapy has been associated with poorer outcomes in Enterococcus faecalis (EF) bacteraemia, the impact of antimicrobial choice, namely β-lactam versus glycopeptide therapy, has not been well described. We sought to determine whether choice of antibiotic affects patient outcomes in EF bacteraemia.
  
  
  METHODS
  This retrospective cohort study was conducted at Liverpool and Bankstown Lidcombe Hospitals, Sydney, Australia between 2006 and 2013. Medical records and laboratory data for consecutive EF bacteraemias were reviewed. Clinical and microbiological data were obtained for all patients who received appropriate antimicrobial therapy with either a β-lactam or a glycopeptide antibiotic. Outcomes and predictors of mortality were determined and treatment groups were compared.
  
  
  RESULTS
  One hundred and seventy-two episodes of clinically significant EF bacteraemias received appropriate antimicrobial therapy with a β-lactam (n = 126) or a glycopeptide (n = 46). All-cause 30 day mortality was 15.1%, with mortality significantly higher in patients receiving glycopeptide therapy compared with β-lactam therapy (26.1% versus 11.1%, P = 0.015). Glycopeptide therapy remained an independent predictor of 30 day mortality [OR 2.46 (95% CI 1.01-6.02), P = 0.048]. APACHE II score [OR 1.10 (95% CI 1.02-1.18), P = 0.011] and malignancy [OR 2.58 (95% CI 1.03-6.49), P = 0.044] were also independent predictors of 30 day mortality.
  
  
  CONCLUSIONS
  Glycopeptide use is associated with increased mortality in patients with EF bacteraemia. In the treatment of β-lactam-susceptible EF bacteraemia, β-lactams should be considered first-line therapy.
authors.affiliation: Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Liverpool, Sydney, NSW, Australia Antibiotic Resistance and Mobile Genetic Elements Group, Microbiology and Infectious Diseases Unit, School of Medicine, University of Western Sydney, Sydney, NSW, Australia hongfoo@ymail.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Foo
authors.affiliation: Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Liverpool, Sydney, NSW, Australia.
authors.forename: Mathew
authors.initials: M
authors.lastname: Chater
authors.affiliation: Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Liverpool, Sydney, NSW, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Maley
authors.affiliation: Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Liverpool, Sydney, NSW, Australia Antibiotic Resistance and Mobile Genetic Elements Group, Microbiology and Infectious Diseases Unit, School of Medicine, University of Western Sydney, Sydney, NSW, Australia.
authors.forename: Sebastiaan J
authors.initials: SJ
authors.lastname: van Hal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001315:Australia; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D013293:Enterococcus faecalis / Q000187:drug effects*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D000667:Ampicillin
keywords: ampicillin; outcomes; vancomycin; β-lactams