Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study

Dubler, Simon; Lenz, Martina; Zimmermann, Stefan; Richter, Daniel C.; Weiss, Karl-Heinz; Mehrabi, Arianeb; Mieth, Markus; Brückner, Thomas; Weigand, Markus; Brenner, Thorsten; Heininger, Alexandra

doi:10.1186/s13756-020-0683-3

Cited by 21 publications

(16 citation statements)

References 52 publications

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“…A higher severity index score was a direct independent risk factor for mortality. Similar to previous reports [ 8 , 18 , 20 ], we also found that the SOFA score increased the risk of poor outcome. Moreover, as for the type of infection, bone and joint infection was classified as decreasing the risk of death.…”

Section: Discussionsupporting

confidence: 92%

“…Previously, several reports showed that patients with VRE versus those with VSE infection did not have a significantly greater risk of mortality [ 19 , 20 , 21 ]. In contrast, our study reported 30-day and 90-day mortality rates for VR- E. faecium infection patients of 57.7% and 69.2%, respectively; these values were obviously higher than those in patients with VS- E. faecium infection cases (38.7% and 47.1%).…”

Section: Discussionmentioning

confidence: 99%

“…However, several previous studies have shown that VRE infection is not associated with increased hospital deaths [ 18 , 19 , 20 , 21 ]. Whether the mortality among patients with VRE infection is higher than that among those with VSE remains a controversial issue.…”

Section: Introductionmentioning

confidence: 99%

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Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

et al. 2021

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The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

et al. 2021

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“…15 Recent Australian and German studies all found point estimates reflecting increased mortality in case of vancomycin resistance, with confidence intervals indicating nonsignificance. [32][33][34] By analyzing the E. faecium bacteremia subset and not including intermediate variables in the adjusted model, the OR of 1.283 (95% CI, 0.801-2.057) from Kramer et al 33 most closely reflects our estimation procedure.…”

Section: Discussionmentioning

confidence: 75%

Attributable mortality of vancomycin resistance in ampicillin-resistant Enterococcus faecium bacteremia in Denmark and the Netherlands: A matched cohort study

Rottier¹,

Pinholt²,

Bij³

2021

Infect. Control Hosp. Epidemiol.

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Objective: To study whether replacement of nosocomial ampicillin-resistant Enterococcus faecium (ARE) clones by vancomycin-resistant E. faecium (VRE), belonging to the same genetic lineages, increases mortality in patients with E. faecium bacteremia, and to evaluate whether any such increase is mediated by a delay in appropriate antibiotic therapy. Design: Retrospective, matched-cohort study. Setting: The study included 20 Dutch and Danish hospitals from 2009 to 2014. Patients: Within the study period, 63 patients with VRE bacteremia (36 Dutch and 27 Danish) were identified and subsequently matched to 234 patients with ARE bacteremia (130 Dutch and 104 Danish) for hospital, ward, length of hospital stay prior to bacteremia, and age. For all patients, 30-day mortality after bacteremia onset was assessed. Methods: The risk ratio (RR) reflecting the impact of vancomycin resistance on 30-day mortality was estimated using Cox regression with further analytic control for confounding factors. Results: The 30-day mortality rates were 27% and 38% for ARE in the Netherlands and Denmark, respectively, and the 30-day mortality rates were 33% and 48% for VRE in these respective countries. The adjusted RR for 30-day mortality for VRE was 1.54 (95% confidence interval, 1.06–2.25). Although appropriate antibiotic therapy was initiated later for VRE than for ARE bacteremia, further analysis did not reveal mediation of the increased mortality risk. Conclusions: Compared to ARE bacteremia, VRE bacteremia was associated with higher 30-day mortality. One explanation for this association would be increased virulence of VRE, although both phenotypes belong to the same well-characterized core genomic lineage. Alternatively, it may be the result of unmeasured confounding.

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“…Yet, a small study comparing older and newer antibiotics in 113 VRE bacteremias concluded that newer antibiotics had not brought discernable benefits to patient outcome [25], A later meta-analysis on the effect of VRE on mortality in the era of effective antibiotic therapy could only present an unadjusted estimate, and hence cannot be compared to our study [13]. Recent Australian and German studies all found point estimates reflecting increased mortality in case of vancomycin resistance, with confidence intervals indicating non-significance [26–28], By analyzing the E. faecium bacteremia subset and not including intermediate variables in the adjusted model, the OR of 1.283 (95% CI 0.801-2.057) from Kramer et al . most closely reflects our estimation procedure [27],…”

Section: Discussionmentioning

confidence: 85%

Attributable mortality of vancomycin resistance in ampicillin-resistant Enterococcus faecium bacteremia in Denmark and the Netherlands: a matched cohort study

Rottier

Pinholt

Bij

et al. 2020

Preprint

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Background: In many European hospitals, ampicillin-resistant Enterococcus faecium (ARE) is endemic, while outbreaks of vancomycin-resistant E. faecium (VRE), belonging to the same genetic lineage, are increasingly reported. We studied the attributable mortality due to vancomycin resistance in patients with E. faecium bacteremia and evaluated whether this is mediated by a delay in appropriate antibiotic therapy. Methods: In a retrospective matched cohort study, patients with VRE bacteremia occurring between 2009 and 2014 in 20 Dutch and Danish hospitals were matched to patients with ARE bacteremia, on hospital, ward, length of hospital stay prior to bacteremia, and age. The risk ratio (RR) for 30-day mortality contrasting VRE with ARE was estimated with further analytic control for confounding factors. Results: In all, 63 VRE and 234 ARE episodes were matched (36 and 130 for the Netherlands and 27 and 104 for Denmark). Crude 30-day mortality was 27% and 38% for ARE in the Netherlands and Denmark, respectively, and 33% and 48% for VRE in the respective countries. The adjusted RR for 30-day mortality for VRE was 1.54 (95% confidence interval (CI) 1.06-2.25). Although appropriate therapy was initiated later for VRE than for ARE bacteremia, this did not appear to mediate the increased mortality risk. Conclusions: Compared to ARE bacteremia, VRE bacteremia was associated with higher 30-day mortality. One explanation for this association would be increased virulence of VRE, although both phenotypes belong to the same well-characterized core genomic lineage. Alternatively, it may be the result of unmeasured confounding.

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Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study

Cited by 21 publications

References 52 publications

Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Attributable mortality of vancomycin resistance in ampicillin-resistant Enterococcus faecium bacteremia in Denmark and the Netherlands: A matched cohort study

Attributable mortality of vancomycin resistance in ampicillin-resistant Enterococcus faecium bacteremia in Denmark and the Netherlands: a matched cohort study

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