1734. Vancomycin-Resistant Enterococcal Bacteremia: Epidemiology, Treatment and Outcome
Session: Poster Abstract Session: Treatment of Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background:

Bloodstream infections (BSI) caused by vancomycin-resistant enterococci (VRE) have acquired considerable importance due to its multiple antimicrobial resistance and high mortality.

Methods:

Retrospective review of all patients with blood cultures positive for Enterococcus faecium and Enterococcus faecalis from January 2010 through June 2012 was performed at a single 900 bed teaching hospital in Detroit. Demographic information, comorbidities and therapeutic details were collected to assess for risk factors and clinical outcomes.

Results:

There were 178 cases of VRE bacteremia identified, 73(41%) E. faecalis and 105(59%) E. faecium. Most of the cases were male 54(%), with a mean age of 62 years. Positive blood culture days ranged from 1-34 days, with a mean duration of 3 days. The hospital length of stay ranged from 3-123 days, average of 27 days.

Table 1. Characteristics of VRE bacteremia cases

Characteristic

N/178   (%)

Healthcare-associated BSI

80        (44.9)

Prior hospitalization in the last one year of BSI

141      (79.2)

Prior use of vancomycin in the last 90days of BSI

128      (71.9)

Symptoms within 7 days of BSI

121      (68.0)

Intensive care unit at date of BSI culture

89        (50.0)

Catheter source of BSI

98        (55.1)

Intra-abdominal source of BSI

47        (26.4)

Urinary source of BSI

19        (10.7)

Endocarditis source of BSI

5          ( 2.8)

Other source of BSI

5          ( 2.8)

Skin source of BSI

3          ( 1.7)

Graft source of BSI

1          ( 0.6)

The most common empiric antimicrobial therapy used was vancomycin (47.8%), then daptomycin (23.6%) and linezolid (17.4%). At the time of discharge 33(18.5%) were on daptomycin, 25(14%) were on linezolid. Duration of antimicrobial therapy ranged from 4-80 days, average of 18 days. 7(3.9%) cases had a change in susceptibility during treatment. Cure was observed in 68(38.2%) cases while 18(10.1%) had relapse. Total deaths were 92(51.7%), 37(20.8%) was attributed to VRE bacteremia. Of the 92 deaths, 43(46.7%) were empirically treated with vancomycin, 22(23.9%) with daptomycin, and 18(19.6%) deaths treated with linezolid.

Conclusion:

VRE remains an important cause of healthcare-associated infection with high mortality rates. Due to the complexity of resistance and limited number of efficacious antimicrobials for VRE appropriate antibiotic selection is vital to treatment success.

Katherine Reyes, MD1, Geehan Sulayman2, Jennifer Jorge3, Samia Arshad, MPH4, Mary Perri, MT4 and Marcus Zervos, MD4, (1)Henry Ford Hospital, Detroit, MI, (2)University of Connecticut, Storrs-Mansfield, CT, (3)Internal Medicine, Henry Ford Hospital, Detroit, MI, (4)Infectious Diseases, Henry Ford Hospital, Detroit, MI

Disclosures:

K. Reyes, None

G. Sulayman, None

J. Jorge, None

S. Arshad, None

M. Perri, None

M. Zervos, None

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