Program Schedule

733
Vancomycin-Resistant Enterococcus (VRE) faecium Bloodstream Infections and Mortality

Session: Poster Abstract Session: Bacteremia: Streptococcal Bacteremia
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • IDSA poster.pdf (612.7 kB)
  • Vancomycin-Resistant Enterococcus (VRE) faecium Bloodstream Infections and Mortality

    Background:

    Enterococci are the third most common cause of healthcare-associated bloodstream infections, and VRE infections, particularly those caused by Enterococcus faecium, are associated with increased morbidity, mortality, length of stay and cost due to antibiotic resistance to several antimicrobial agents.

    Methods:

    A retrospective review of electronic medical records from January 2010 to December 2013 of VRE faecium bloodstream infections (BSI) at single 900 bed teaching hospital in Detroit.  Patients identified through microbiology records.  Demographics, comorbidities, and therapeutic antibiotic regimens used were evaluated to assess risk factors and outcome.

    Results:

    A total of 159 cases of VRE E. faecium BSI were identified.  Mean age was 62 years with 54% male.  Fifty percent of bacteremia cases occurred in ICU, 31% in wards, 18% in ED.  Common sources of infection were catheter-related (44%), intra-abdominal (35%), urinary tract (11%).  Isolates were hospital-acquired (64%) and health-care associated (35%).  Common underlying comorbidities were AKI (54%), immunosuppression (47%), CKD (40%), diabetes (35%), malignancy (34.5%), dialysis (31%) and liver disease (27%).  Endocarditis occurred in 6%.  Patients received the following treatments: daptomycin (D) 38%, linezolid (L) 23%, combination of D followed by L 27%, or no therapy 11%.  Ninety-day mortality was 44%.  There was a difference in location onset (ICU 61% vs 40%), infection origin (hospital-acquired 74% vs 56%), source of infection (intra-abdominal 44% vs 27%) and comorbidities between the expired and non-expired group.  Hematologic malignancies were 37% in expired vs 10% in survived, cirrhosis 37% vs 19%, dialysis 43% vs 21%.  There was no difference between age, gender or choice of antibiotic use.  In the patients who expired, 39% received D, 19% L, 20% combination of both, 20% received no therapy.  In survival group, 37% received D, 26% L, 37% both D and L, 4.5% no therapy.

    Conclusion:

    Mortality in VRE faecium bloodstream infections was more common in patients with severe underlying disease, ICU onset, hospital-acquired infection, intra-abdominal source and receipt of ineffective antibiotics.  

    Geehan Suleyman, MD1, Tyler Prentiss1, Dora Vager, B.S.1, Mary Perri, MT1, Daniela Moreno, B.S.1, Samia Arshad, MPH1, Marcus Zervos, MD1,2 and Katherine Reyes, MD1, (1)Henry Ford Health System, Detroit, MI, (2)Wayne State University, Detroit, MI

    Disclosures:

    G. Suleyman, None

    T. Prentiss, None

    D. Vager, None

    M. Perri, None

    D. Moreno, None

    S. Arshad, Pfeizer: Research Contractor, Grant recipient
    Cubist: Research Contractor, Grant recipient
    Forest Research Institute: Research Contractor, Grant recipient

    M. Zervos, Forest Research Institute: Grant Investigator, Research grant
    Durata: Grant Investigator, Research grant
    Teptraphase: Grant Investigator, Research grant
    Pfizer: Grant Investigator, Research grant
    Merck: Grant Investigator, Research grant
    Cempra: Grant Investigator, Research grant

    K. Reyes, None

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