Enterococci often cause hospital-associated bloodstream infections in critically ill and immunocompromised patients. Prospective studies to assess the clinical impact of enterococcal bacteremia (EB) are lacking. We conducted a prospective study to investigate the clinical and microbiological factors associated with mortality in EB.
Adults with EB were prospectively followed in 3 US tertiary hospitals from September 2016 to March 2018. Individuals with EB for whom follow-up blood culture data within 7 days of index culture were available were included. Microbiologic failure (MF) was defined as clearance of bacteremia ≥4 days after the 1st blood culture. The main outcome was hospital mortality.
A total of 282 patients were included with 69 (24%) infected with vancomycin-resistant enterococci (VRE). The majority of patients were male (60%) with a median age of 63 y. Median length of hospitalization for VRE patients was longer (25 d) than non-VRE (13 d, p<0.001). E. faecium corresponded to 77% of VRE isolates, whereas E. faecalis comprised 72% of non-VRE. The average time to first blood culture was 16 d for VRE vs 4 d for non-VRE (P<0.001). Patients with VRE were more likely to have hematological malignancy or bone marrow transplant (p<0.003), whereas patients infected non-VRE were more likely to have solid tumors (p=0.02). The most common antibiotic used was daptomycin as monotherapy for both VRE and non-VRE with a median dose of 8 mg/kg for both groups. Overall mortality was 25% (43% vs 20% in VRE vs non-VRE patients, respectively; p<0.0001). Factors significantly associated with mortality in univariate analyses included ICU admission, prolonged hospitalization, hematological malignancy, use of immunosuppressive therapy, hemodialysis, neutropenia (<500 cell/ml), Pitt bacteremia score >3, infection with VRE and MF. ICU admission (RR 3.3; 95% CI 1.7-7.5, neutropenia (RR 4.1; 95% CI 1.3-12.9), Pitt bacteremia score >3 (RR 6.8; 95% CI 2.6-18.0), MF (RR 4.7; 95% CI 2.2-10.3) and infection with VRE (RR 4.1; 95% CI 1.1-16.6) remained significantly associated with mortality in multivariate analyses.
Presence of VRE in EB and MF are associated with increased mortality. EB represent a major burden of disease in hospital settings.
K. C. Reyes, None
P. Sahasrabhojane, None
H. Misikir, None
H. Garza, None
M. J. Zervos, None
S. L. Aitken, None
S. A. Shelburne, None
C. Arias, Merck & Co., Inc.: Grant Investigator , Research support . MeMed: Grant Investigator , Research support . Allergan: Grant Investigator , Research support .