Clinical epidemiology of vancomycin-resistantEnterococcus gallinarumandEnterococcus casseliflavusbloodstream infections.
This study aimed to evaluate the clinical outcomes of vancomycin-resistant enterococcal bloodstream infections (VRE BSI) caused byEnterococcus gallinarumorEnterococcus casseliflavus. Variables associated with treatment failure were determined and treatment options were compared. This was a national retrospective study of hospitalised Veterans Affairs patients with non-faecium, non-faecalisVRE BSI. The primary outcome was treatment failure, defined as a composite of: (i) 30-day all-cause mortality; (ii) microbiological failure; and (iii) 30-day VRE BSI recurrence. Stepwise Poisson regression was conducted to determine variables associated with treatment failure. In total, 48 patients were included, with 29 cases (60.4%) caused byE. gallinarumand 19 cases (39.6%) caused byE. casseliflavus. Among these cases, 20 (41.7%) were treated with an anti-VRE agent (linezolid or daptomycin) and 28 (58.3%) were treated with an anti-enterococcal β-lactam. Overall, 30-day mortality was 10.4% (5/48) and composite treatment failure was 39.6% (19/48). In multivariate analysis, treatment with an anti-enterococcal β-lactam was associated with increased treatment failure in comparison with anti-VRE therapy (adjusted risk ratio = 1.73, 95% confidence interval 1.06-4.97;P= 0.031). Overall, treatment with linezolid or daptomycin for vancomycin-resistantE. gallinarum or E. casseliflavusBSI resulted in improved clinical outcomes in comparison with anti-enterococcal β-lactam treatment.
Department of Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, Kansas, USA; Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas, USA; Pharmacy Service, Dwight D. Eisenhower Veterans Affairs Medical Center, Leavenworth, Kansas, USA.
Nicholas S
NS
Britt
Pharmacy Service, Dwight D. Eisenhower Veterans Affairs Medical Center, Leavenworth, Kansas, USA.
Emily M
EM
Potter
Bloodstream infection; Daptomycin; Linezolid; Vancomycin-resistant enterococci