title: VRE and VSE Bacteremia Outcomes in the Era of Effective VRE Therapy: A Systematic Review and Meta-analysis.
abstract: BACKGROUND Prior data suggest that vancomycin-resistant Enterococcus (VRE) bacteremia is associated with worse outcomes than vancomycin-sensitive Enterococcus (VSE) bacteremia. However, many studies evaluating such outcomes were conducted prior to the availability of effective VRE therapies. OBJECTIVE To systematically review VRE and VSE bacteremia outcomes among hospital patients in the era of effective VRE therapy. METHODS Electronic databases and grey literature published between January 1997 and December 2014 were searched to identify all primary research studies comparing outcomes of VRE and VSE bacteremias among hospital patients, following the availability of effective VRE therapies. The primary outcome was all-cause, in-hospital mortality, while total hospital length of stay (LOS) was a secondary outcome. All meta-analyses were conducted in Review Manager 5.3 using random-effects, inverse variance modeling. RESULTS Among all the studies reviewed, 12 cohort studies and 1 case control study met inclusion criteria. Similar study designs were combined in meta-analyses for mortality and LOS. VRE bacteremia was associated with increased mortality compared with VSE bacteremia among cohort studies (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.38-2.35; I2=0%; n=11); the case-control study estimate was similar, but not significant (OR, 1.93; 95% CI, 0.97-3.82). LOS was greater for VRE bacteremia patients than for VSE bacteremia patients (mean difference, 5.01 days; 95% CI, 0.58-9.44]; I2=0%; n=5). CONCLUSIONS Despite the availability of effective VRE therapy, VRE bacteremia remains associated with an increased risk of in-hospital mortality and LOS when compared to VSE bacteremia. Infect. Control Hosp. Epidemiol. 2015;37(1):26-35.
authors.affiliation: 1Infection Prevention and Control,Public Health Ontario,Toronto,Ontario,Canada.
authors.forename: Chatura
authors.initials: C
authors.lastname: Prematunge
authors.affiliation: 1Infection Prevention and Control,Public Health Ontario,Toronto,Ontario,Canada.
authors.forename: Colin
authors.initials: C
authors.lastname: MacDougall
authors.affiliation: 1Infection Prevention and Control,Public Health Ontario,Toronto,Ontario,Canada.
authors.forename: Jennie
authors.initials: J
authors.lastname: Johnstone
authors.affiliation: 1Infection Prevention and Control,Public Health Ontario,Toronto,Ontario,Canada.
authors.forename: Kwaku
authors.initials: K
authors.lastname: Adomako
authors.affiliation: 1Infection Prevention and Control,Public Health Ontario,Toronto,Ontario,Canada.
authors.forename: Freda
authors.initials: F
authors.lastname: Lam
authors.affiliation: 1Infection Prevention and Control,Public Health Ontario,Toronto,Ontario,Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robertson
authors.affiliation: 1Infection Prevention and Control,Public Health Ontario,Toronto,Ontario,Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Garber
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016896:Treatment Outcome; D065507:Vancomycin-Resistant Enterococci
chemical_list: D000900:Anti-Bacterial Agents