Outcomes of Antimicrobial Treatment and Predictors of Mortality in Vancomycin-resistant Enterococcus faecium Bacteremia
Date Issued
2011
Date
2011
Author(s)
Chen, Ying-Yu
Abstract
Background:
Vancomycin-resistant Enterococcus faecium (VREfm) bacteremia has increased rapidly in recent years. Because few agents have activity against VREfm, it is difficult to treat VREfm bacteremia. However, there were limited studies that analyzed treatment outcomes and prognosis of VREfm bacteremia.
Objectives:
The present study was performed to evaluate the influence of anti-VRE therapy on prognosis of VREfm bacteremia patients and treatment outcomes of different antibiotic regimens. Risk factors for 30-day mortality were also assessed.
Study design and study population:
A retrospective chart review was conducted at National Taiwan University Hospital (NTUH), a medical center in northern Taiwan. Patients with bacteremia due to VREfm between January 1, 2009 and December 31, 2010 were enrolled. Only the first episode of bacteremia for each patient was included in the analysis. Patients younger than 18 years old or with incomplete medical records were excluded.
Methods:
Data were collected from medical records, including demographic data, underlying diseases, predisposing factors for infection, clinical presentation at the onset of VREfm bacteremia, laboratory data, microbiological data, antimicrobial treatment and outcomes. The primary end point was 30-day all-cause mortality. Univariate and multivariate stepwise logistic regression analyses were performed to determine risk factors for mortality and outcomes of antimicrobial treatment.
Results:
Ninety-four patients were enrolled in this study, and ninety-three (98.9%) were nosocomial infection. Among patients with VREfm bacteremia, forty-three (45.7%) patients were monomicrobial infection. The mean age was 60.9±17.1 years old and 57.4% were men. The most common underlying diseases were malignancy (62.8%), followed by cardiovascular diseases (55.3%). At the onset of bacteremia, 40.4% had septic shock and the mean APACHE II score was 22.9±8.9. The 30-day mortality was 55.3% for all patients and was 48.8% for patients with monomicrobial infection.
Among patients with monomicrobial infection, receipt of anti-VRE therapy did not affect 30-day mortality (P=0.67). When further analyzing the treatment outcome between linezolid and daptomycin, there was no significant difference on 30-day mortality (57.1% vs. 35.7%，P=0.26).
Multivariate logistic regression of patients with VREfm bacteremia showed that Charlson’s comorbidity index (odds ratio 1.47, 95%CI 1.12-1.93, P=0.006), septic shock (odds ratio 3.13, 95%CI 1.08-9.05, P=0.0035), APACHE II score≧23 (odds ratio 6.52, 95%CI 2.35-18.12, P=0.0003) were independent risk factors for 30-day mortality, but anti-VRE therapy was not associated with 30-day mortality (odds ratio 1.09, 95%CI 0.37-3.24, P=0.88). Among patients with monomicrobial infection, multivariate logistic regression revealed that only APACHE II score≧23 was associated with 30-day mortality (odds ratio 14.15, 95%CI 2.63-75.98, P=0.002), and higher Charlson’s comorbidity index showed a trend towards higher mortality (odds ratio 1.53, 95%CI 0.96-2.44, P=0.07). However, anti-VRE therapy was not a significant risk factor for 30-day mortality (odds ratio 1.19, 95%CI 0.21-6.92, P=0.84).
Conclusions:
This study showed that severity of illness and comorbidity at the onset of VREfm bacteremia had a significant influence on prognosis of patients, but receipt of anti-VRE therapy did not improve survival for patients.
Subjects
Antimicrobial treatment
bacteremia
mortality
risk factors
vancomycin-resistant
SDGs
Type
thesis
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