502. Epidemiology and Outcomes of Enterococcal Infective Endocarditis (EIE)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Enterococcus spp. are currently a leading cause of infective endocarditis in both the United States and internationally. We sought to describe the characteristics and outcomes of patients with enterococcal bloodstream infection (EBSI) and EIE at an urban tertiary care center.
Methods: Retrospective cohort of pts with EBSI from 2006-08 at a 903-bed hospital in Detroit. Definite and possible EIE cases were identified using modified Duke Criteria. Data collected: medical history, microbiology, treatment and all-cause mortality.
Results: Among 200 patients, 39 (19.5%) EIE were identified (25 definite, 14 possible). Characteristics more common in pts with EIE included: injection drug use (15% vs 4%), younger age (median 57 vs 64 years), hemodialysis (41% vs 26%), CAD (38% vs 24%), community onset infection (25% vs 12%), infection with E. faecalis (72% vs 49%), and concomitant catheter-related infection (36% vs 14%). In logistic regression analysis, independent risk factors for EIE included (adj OR, 95%CI) prior endocarditis (34.0, 4-320), catheter-related infection (4.7, 1.9-11.7) and community onset infection (2.9, 1.1-8.1). Characteristics of patients with Vancomycin susceptible (VSE) and vancomycin resistant (VRE) EIE are presented in Table 1.
Conclusions: EBSI and EIE are associated with high rates of morbidity and mortality, and are complicated by vancomycin resistance and comorbid conditions. Interventions to improve outcome of EIE, and VRE endocarditis in particular, are needed.
Table 1. Characteristics of 39 Patients with vancomycin susceptible or resistant enterococcal endocarditis; data presented as Number with each characteristic; p values reflect Fisher’s exact or Mann Whitney U as appropriate
VariableVSE (n=19)VRE (n=20)P-value
Organism
E. faecalis
E. faecium
Other
--
16
1
2
--
10
9
1
.033
Comorbid conditions
Hemodialysis
CAD
Diabetes
Prior vancomycin use
Healthcare associated
--
5
4
5
7
10
--
11
11
10
13
19
--
.105
.048
.184
.113
.003
Vegetation location by TEE/TTE
Pulmonic valve
Tricuspid valve
Mitral valve
Aortic valve
--
1
2
6
6
--
0
2
8
6
Not tested
Valve surgery performed73Not tested
Primary Antimicrobial Therapy
Vancomycin monotherapy
Ampicillin monotherapy
Linezolid monotherapy
Daptomycin monotherapy
Aminoglycoside-based combo
Other combo
--
3
5
0
2
8
1
--
0
3
7
5
3
2
Not tested
Time to active therapy (days)
Length of Hospital Stay (days)
Duration of bacteremia (days)
Total duration of therapy (days)
1
21
2.5
42
2
20
4
28
.553
.857
.017
.093
Mortality rate
In hospital
6-month
2
5
5
12
.407
.038
Rachel Chambers, PharmD1, Susan L Davis, PharmD2, Jeff Hurren, PharmD1, Lindsay Lessl, PharmD Candidate3, Jason Watt, PharmD Candidate3, Marcus Zervos, MD4 and  J. Hurren, None..
J. E. Watt, None..
L. K. Lessl, None..
R. M. Chambers, None..
M. Zervos, None. 
S. L. Davis,
Pfizer Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee), Speaker's Bureau, Received: Research Support, Speaker Honorarium., (1)Henry Ford Hospital, Detroit, MI, (2)Wayne State University College of Pharmacy, Detroit, MI, (3)Wayne State University, Detroit, MI, (4)Infectious Disease, Henry Ford Hospital, Detroit, MI