Enterococcus spp. are a common cause of healthcare-associated infections (HAIs). While infections due to VRE have been well characterized, clinical outcomes for DNSE and LNSE have not been widely reported.
We performed a retrospective chart review on adult patients with DNSE and/or LNSE isolates from January 1, 2011 - December 31, 2013. Minimum inhibitory concentration (MIC) >4 was used for DNSE, MIC >2 for LNSE.
A total of 116 isolates were identified with DNSE alone (n = 74), LNSE alone (n = 2), or resistant to both (n = 40). Mean age was 59 years and 53% were male. The majority of the patients had cardiac co-morbidities (79.3%), followed by gastrointestinal (59.5%) and hematologic/oncologic (58.6%). 38 patients (32.8%) were immunocompromised of which 29 (25%) were transplant recipients. The mean hospital length of stay was 30 days and 44% of patients required ICU care. 28 patients (24%) required mechanical ventilation and 35 (30.2%) had central venous catheters. Readmission within 90 days occurred among 31% of patients. Of the 116 isolates, 72 (62%) were considered to be clinically significant and warranted treatment. There were a total of 19 bloodstream infections (BSI). The most common site was urine (32%), followed by BSI (26%), wounds (25%), and then body fluid (17%). The all cause mortality for the entire patient cohort was 18%. All cause mortality among patients with clinically significant infection was 23.6%. There was a 4.7 fold increase in mortality (p=0.0067) in patients with VRE bacteremia in association with daptomycin non-susceptibility and/or linezolid non-susceptibility (mortality =42%). Immunocompromised hosts with daptomycin and/or linezolid non-susceptibility had a 4.5 higher odds of mortality (p=0.0016). The average time to appropriate antibiotics was 5 days. Patients given appropriate antibiotic therapy within 2 days had a 49% reduced odds of mortality during admission (p=0.3177) but this was not statistically significant.
In addition to vancomycin resistance, enterococcus with reduced susceptibility to daptomycin and linezolid is emerging as an important cause of HAIs. Immunocompromised hosts and bacteremia are associated with high rates of mortality in patients infected with DNSE and/or LNSE.
J. Zakrzewski, None
G. Balba, None
R. Teran, None
B. Toimil, None
L. Duong, None
P. Kumar, None
J. Timpone, None
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