Risk Factors for 30-Day Mortality in Nosocomial Enterococcal Bloodstream Infections

Enterococci commonly cause nosocomial bloodstream infections (BSIs), and the global incidence of vancomycin-resistant enterococci (VRE) BSIs is rising. This study aimed to assess the risk factors for enterococcal BSIs and 30-day mortality, stratified by <i>Enterococcus</i> species, vanco...

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Main Authors: Verena Zerbato (Author), Riccardo Pol (Author), Gianfranco Sanson (Author), Daniel Alexandru Suru (Author), Eugenio Pin (Author), Vanessa Tabolli (Author), Jacopo Monticelli (Author), Marina Busetti (Author), Dan Alexandru Toc (Author), Lory Saveria Crocè (Author), Roberto Luzzati (Author), Stefano Di Bella (Author)
Format: Book
Published: MDPI AG, 2024-06-01T00:00:00Z.
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Summary:Enterococci commonly cause nosocomial bloodstream infections (BSIs), and the global incidence of vancomycin-resistant enterococci (VRE) BSIs is rising. This study aimed to assess the risk factors for enterococcal BSIs and 30-day mortality, stratified by <i>Enterococcus</i> species, vancomycin resistance, and treatment appropriateness. We conducted a retrospective cohort study (2014-2021) including all hospitalized adult patients with at least one blood culture positive for <i>Enterococcus faecalis</i> or <i>Enterococcus faecium</i>. We included 584 patients with enterococcal BSI: 93 were attributed to vancomycin-resistant <i>E. faecium</i>. The overall 30-day mortality was 27.5%; higher in cases of BSI due to vancomycin-resistant <i>E. faecium</i> (36.6%) and vancomycin-sensitive <i>E. faecium</i> (31.8%) compared to <i>E. faecalis</i> BSIs (23.2%) (<i>p</i> = 0.016). This result was confirmed by multivariable Cox analysis. Independent predictors of increased mortality included the PITT score, complicated bacteremia, and age (HR = 1.269, <i>p</i> < 0.001; HR = 1.818, <i>p</i> < 0.001; HR = 1.022, <i>p</i> = 0.005, respectively). Conversely, male gender, consultation with infectious disease (ID) specialists, and appropriate treatment were associated with reduced mortality (HR = 0.666, <i>p</i> = 0.014; HR = 0.504, <i>p</i> < 0.001; HR = 0.682, <i>p</i> = 0.026, respectively). In conclusion, vancomycin-resistant <i>E. faecium</i> bacteremia is independently associated with a higher risk of 30-day mortality.
Item Description:10.3390/antibiotics13070601
2079-6382