Hostname: page-component-7b9c58cd5d-g9frx Total loading time: 0 Render date: 2025-03-15T14:39:42.123Z Has data issue: false hasContentIssue false
  • English
  • Français

Enterococcal Bacteremia: Risk Factors for Vancomycin Resistance and Predictors of Mortality

Published online by Cambridge University Press:  02 January 2015

Ebbing Lautenbach ,
Warren B. Bilker  and
Patrick J. Brennan
Ebbing Lautenbach
Affiliation:
Infectious Diseases Division, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Patrick J. Brennan*
Affiliation:
Infectious Diseases Division, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
*
Infectious Diseases Division, 9 Gates Blag, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify risk factors for vancomycin resistance and mortality in enterococcal bacteremia.

Design:

Historical cohort study.

Setting:

A large academic medical center with a high prevalence of vancomycin-resistant enterococci (VRE).

Patients:

Two hundred sixty patients with enterococcal bacteremia, of whom 72 (28%) had VRE.

Results:

Independent risk factors for infection with VRE were the mean number of antibiotic days (P<.001), renal insufficiency (P<.001), mean days of vancomycin use (P=.005), and neutropenia (P=.013). A trend toward a significant association between metronidazole use and VRE also was noted (P=.068). Mortality was attributable to the bacteremia in 96 patients (37%). Severity of illness (P<.001) and age (P=.020) were independent risk factors for mortality. Vancomycin resistance was not, however, an independent predictor of mortality.

Conclusion:

These results suggest that restrictions on antibiotic use, particularly in patients with renal insufficiency and neutropenia, may help to combat the rising incidence of VRE. Although patients with VRE bacteremia demonstrated higher mortality rates than patients with infection due to susceptible isolates, vancomycin resistance was not an independent predictor of mortality in these patients and likely serves more as a marker of underlying severity of illness.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 5 , May 1999 , pp. 318 - 323
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Schaberg, DR, Culver, DH, Gaynes, RP. Major (rends in microbial etiology of nosocomial infection. Am J Med 1991;91(suppl 3B):72S–75S.CrossRefGoogle Scholar
2. Banerjee, SN, Emori, TG, Culver, DH, Gaynes, RP, Jarvis, WR, Horan, T, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System. Am J Med 1991;91(suppl 3B):86S–89S.Google Scholar
3. Landry, SL, Kaiser, DL, Wenzel, RR Hospital stay and mortality attributed to nosocomial enterococcal bacteremia: a controlled study. Am J Infect Control 1989;17:323–329.Google Scholar
4. Toala, P, McDonald, A Wilcox, C, Finland, M. Susceptibility of group D streptococcus (enterococcus) to 21 antibiotics in vitro, with special reference to species differences. Am J Med Sci 1969;258:416–430.CrossRefGoogle Scholar
5. Uttley, AHC, Collins, CH, Naidoo, J, George, RC. Vancomycin-resistant enterococci. Lancet 1988;1:57–58. Letter.Google Scholar
6. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
7. Noble, WC, Virani, Z, Cree, R Cotransfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC12201 to Staphylococcus aureus . FEMS Microbiology Letters 1992;93:195–198.Google Scholar
8. Noskin, GA, Peterson, LR, Warren, JR. Enterococcus faecium and Enterococcus faecalis bacteremia: acquisition and outcome. Clin Infect Dis 1995;20:296–301.CrossRefGoogle ScholarPubMed
9. Noskin, GA Till, M, Patterson, BK, Clarke, JT, Warren, JR. High-level gentamicin resistance in Enterococcus faecalis bacteremia. J Infect Dis 1991;164:1212–1215.Google Scholar
10. Linden, PK, Pasculle, AW, Manez, R, Kramer, DJ, Fung, JJ, Pinna, AD, et al. Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus, faecium or vancomycin-susceptible E faecium . Clin Infect Dis 1996;22:663–670.CrossRefGoogle ScholarPubMed
11. Cockcroft, DW, Gault, MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.Google Scholar
12. Weinstein, MP, Murphy, JR, Relier, LB, Lichtenstein, KA. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults; II: clinical observations, with special reference to factors influencing prognosis. Rev Infect Dis 1983;5:54–70.Google Scholar
13. Chow, JW, Fine, MJ, Shlaes, DM, Quinn, JP, Hooper, DC, Johnson, MP, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med 1991;115:585–591.CrossRefGoogle ScholarPubMed
14. Norris, AH, Reilly, JP, Edelstein, PH, Brennan, PJ, Schuster, MG. Chloramphenicol for the treatment of vancomycin-resistant enterococcal infections. Clin Infect Dis 1995;20:1137–1144.Google Scholar
15. Hosmer, DW, Lemeshow, S. Applied Logistic Regression. New York, NY: John Wiley & Sons; 1989.Google Scholar
16. Montecalvo, MA Horowitz, H, Gedris, C, Carbonaro, C, Tenover, FC, Issah, A, et al. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resis-tant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.Google Scholar
17. Stroud, L, Edwards, J, Danzig, L, Culver, D, Gaynes, R Risk factors for mortality with enterococcal bloodstream infections. Infect Control Hosp Epidemiol 1996;17:576–578.Google Scholar
18. Handwerger, S, Raucher, B, Altarac, D, Monka, J, Marcinone, S, Singh, KV, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillm, and gentamicm. Clin Infect Dis 1993;16:750–755.Google Scholar
19. Edmond, MB, Ober, JF, Weinbaum, DL, Kaller, MA Hwang, T, Sanford, MD, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1126–1133.Google Scholar
20. Shay, DK, Maloney, SA Montecalvo, M, Banerjee, S, Wormser, GR Arduino, MJ, et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis 1995;172:993–1000.Google Scholar
21. Ruiz, R Gomez, F, Schreiber, AD. Impaired function of macrophage Fc receptors in end-stage renal disease. N Engl J Med 1990;332:717–722.CrossRefGoogle Scholar
22. Awada, A, Van der Auwera, P, Meunier, F, Daneau, D, Klastersky, J. Streptococcal and enterococcal bacteremia in patients with cancer. Clin Infect Dis 1992;15:33–48.Google Scholar
23. Edmond, MB, Ober, JF, Dawson, JD, Weinbaum, DL, Wenzel, RP. Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin Infect Dis 1996;23:1234–1239.Google Scholar
24. Cohen, ML. Epidemiology of drug resistance: implications for a post-antimicrobial era. Science 1992;257:1050–1055.CrossRefGoogle ScholarPubMed
25. Hospital Infection Control Practices Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105–113.Google Scholar