title: Clinical characteristics and risk factors of enterococcal infections in Nagasaki, Japan: a retrospective study.
abstract: BACKGROUND
  Enterococcus spp. are particularly important etiological agents of nosocomial infections. However, the clinical characteristics of and risk factors for enterococcal infections in clinical settings are poorly understood.
  
  
  METHODS
  The sample included patients with Enterococcus spp. infections detected from clinical samples at Nagasaki University Hospital between 2010 and 2011 and patients with enterococcal colonization (control patients). In this retrospective study, the risk factors for enterococcal infections were analyzed by comparing infected and control patients via multivariate logistic regression.
  
  
  RESULTS
  A total of 182 infected (mean age, 64.6 ± 18.2 years; 114 men) and 358 control patients (patients with enterococcal colonization) (mean age, 61.6 ± 22.4 years; 183 men) were included. Enterococcal infections were classified as intraperitoneal (n = 87), urinary tract (n = 28), or bloodstream (n = 20) infections. Cancer and hematological malignancies were the most common comorbidities in enterococcal infections. Carbapenem and vancomycin were administered to 43.8 % and 57.9 % of patients infected with Enterococcus faecalis and Enterococcus faecium, respectively. No vancomycin-resistant enterococci were isolated. Multivariate analysis identified abdominal surgery (odds ratio [OR], 2.233; 95 % confidence interval [CI], 1.529-3.261; p ≤ 0.001), structural abnormalities of the urinary tract (OR, 2.086; 95 % CI, 1.088-4.000; p = 0.027), male sex (OR, 1.504; 95 % CI, 1.032-2.190; p = 0.033), and hypoalbuminemia (OR, 0.731; 95 % CI, 0.555-0.963; p = 0.026) as independent risk factors for enterococcal infections. Multivariate analysis showed abdominal surgery (OR, 2.263; 95 % CI, 1.464-3.498; p ≤ 0.001), structural abnormalities of the urinary tract (OR, 2.634; 95 % CI, 1.194-5.362; p = 0.008), and hypoalbuminemia (OR, 0.668; 95 % CI, 0.490-0.911; p = 0.011) were independent risk factors for E. faecalis infection. Finally, immunosuppressive agent use (OR, 3.837; 95 % CI, 1.397-10.541; p = 0.009) and in situ device use (OR, 3.807; 95 % CI, 1.180-12.276; p = 0.025) were independent risk factors for E. faecium infection.
  
  
  CONCLUSIONS
  These findings might inform early initiation of antimicrobial agents to improve clinical success.
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. toshikikajihara@hiroshima-u.ac.jp.|Department of Molecular and Internal Medicine, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan. toshikikajihara@hiroshima-u.ac.jp.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Kajihara
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. shigekinak@nih.go.jp.|Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan. shigekinak@nih.go.jp.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. naokiwanaga.53.redstar@gmail.com.
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwanaga
authors.affiliation: Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. d011eb@yahoo.co.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Oshima
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. takahiro-takazono@nagasaki-u.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Takazono
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. taiga-m@nagasaki-u.ac.jp.
authors.forename: Taiga
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. koizumik@nagasaki-u.ac.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.affiliation: Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan. K-yanagi@nagasaki-u.ac.jp.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.affiliation: Department of Molecular and Internal Medicine, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan. nokohno@hiroshima-u.ac.jp.
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Kohno
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. s-kohno@nagasaki-u.ac.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use; D013293:Enterococcus faecalis / Q000187:drug effects / Q000302:isolation & purification; D016984:Enterococcus faecium / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D007166:Immunosuppressive Agents; D014640:Vancomycin