Epidemiology, treatment and outcome of patients with vancomycin resistant enterococcal (VRE) bacteremia (BSI)

A retrospective chart review of 100 patients with VRE BSI and 102 with vancomycin sensitive enterococcus (VSE) BSj was done. Age, sex, ethnicity, underlying illness, admission service, median length of stay (LOS), and APACHE II score calculated 24 hours prior to the first positive blood culture did not differ significantly. Significant risk factors (p<0.05) for VRE acquisition included hospitalization prior to infection (VRE 89% vs. VSE 74%), LOS prior to infection (VRE 19 days vs. VSE 5 days), antibiotics prior to infection (VRE 92% vs. VSE 67%), concurrent infection (VRE 72% vs. VSE 59%), invasive procedure prior to infection (VRE 53% vs. VSE 35%), nosocomial acquisition (VRE 91 % vs. VSE 73%), duration of TPN (VRE 15 days vs. VSE 8 days), duration of ventilation (VRE 18 days vs. VSE 11 days) and location in the respiratory step-down unit at the time of infection IVRE 10% vs. VSE 3%). Antibiotics associated with VRE acquisition were cephalosporins, aminoglycosides, vancomycin, penicillins and anti-anaerobic agents. A central line catheter was more likely the source of infection in the VRE group (VRE 58% vs. VSE 25%). The crude mortality rate was somewhat higher for the VRE group (VRE 48% vs. VSE 36%). The relation of enterococcal acteremia to death did not differ between the two groups. In the VRE group alone there was no significant difference in the mortality between treated and untreated patients (treated 48% vs. untreated 48%). Patients with VRE were treated with one or more of the following: vancomycin. ampicillin, penicillins, aminoglycosides, imipenem, ciprofloxacin, doxycycline and chloramphenicol. The mortality and clinical response in the VRE group did not differ with the antibiotic regimen chosen for therapy. Significant factors (p<0.05) for mortality within the VRE group included prior hospitalization (expired 96% vs. survived 81 %) and prior antibiotic therapy (expired 94% vs. survived 79%). Those that received cephalosporins or vancomycin prior to infection with VRE had a significant increase in mortality.