Enterococcal bacteraemia: factors influencing mortality, length of stay and costs of hospitalization

Abstract

Enterococci are a major cause of nosocomial bacteraemia. The impacts of vanB vancomycin resistance and antibiotic therapy on outcomes in enterococcal bacteraemia are unclear. Factors that affect length of stay (LOS) and costs of managing patients with enterococcal bacteraemia are also unknown. This study aimed to identify factors associated with mortality, LOS and hospitalization costs in patients with enterococcal bacteraemia and the impact of vancomycin resistance and antibiotic therapy on these outcomes. Data from 116 patients with vancomycin-resistant Enterococci (VRE), matched 1:1 with patients with vancomycin-susceptible Enterococcus (VSE), from two Australian hospitals were reviewed for clinical and economic outcomes. Univariable and multivariable logistic and quantile regression analyses identified factors associated with mortality, LOS and costs. Intensive care unit admission (OR, 8.57; 95% CI, 3.99-18.38), a higher burden of co-morbidities (OR, 4.55; 95% CI, 1.83-11.33) and longer time to appropriate antibiotics (OR, 1.02; 95% CI, 1.01-1.03) were significantly associated with mortality in enterococcal bacteraemia. VanB vancomycin resistance increased LOS (4.89 days; 95% CI, 0.56-11.52) and hospitalization costs (AU$ 28 872; 95% CI, 734-70 667), after adjustment for confounders. Notably, linezolid definitive therapy was associated with lower mortality (OR, 0.13; 95% CI, 0.03-0.58) in vanB VRE bacteraemia patients. In patients with VSE bacteraemia, time to appropriate antibiotics independently influenced mortality, LOS and hospitalization costs, and underlying co-morbidities were associated with mortality. The study findings highlight the importance of preventing VRE bacteraemia and the significance of time to appropriate antibiotics in the management of enterococcal bacteraemia.

Molecular Epidemiology of Enterococcal Bacteremia in Australia

“…The relative clinical importance of E. faecium bacteremia has increased with the emergence of resistance to antimicrobials such as ampicillin and vancomycin (28,29). In at least one Australian institution, VRE bacteremia has reportedly surpassed methicillinresistant Staphylococcus aureus (MRSA) bacteremia (18).…”

Superior Sensitivity and Decreased Time to Detection with the Bactec Peds Plus/F System Compared to the BacT/Alert Pediatric FAN Blood Culture System

“…The timely removal of central venous catheters (19) and early initiation of optimized antibiotics (e.g., nafcillin, oxacillin, or cefazolin in methicillin-susceptible S. aureus bacteremia) have been associated with a reduction in the number of treatment failures (21,22). Similarly, delayed initiation of targeted enterococcal therapy has been associated with increased lengths of hospital stay and risk of mortality, regardless of the vancomycin susceptibility status (23,24). This study provides evidence that the superior sensitivity and swifter time to detection attributed to the Bactec Aerobic Plus/F system also applies to the Bactec Peds Plus product.…”

Rapid Detection of Gram-Positive Organisms by Use of the Verigene Gram-Positive Blood Culture Nucleic Acid Test and the BacT/Alert Pediatric FAN System in a Multicenter Pediatric Evaluation

“…Similarly, delayed initiation of targeted enterococcal therapy has been associated with increased lengths of hospital stays and mortality rates, regardless of vancomycin susceptibility status (7)(8)(9). Rapid detection of Enterococcus spp.…”