Enterococcus faecalis bloodstream infection: does infectious disease specialist consultation make a difference?

Abstract

Purpose To evaluate the relationship between mortality or relapse of bloodstream infection (BSI) due to Enterococcus faecalis and infectious diseases specialist consultation (IDC) and other factors potentially associated with outcomes. Methods In a tertiary-care center, consecutive adult patients with E. faecalis BSI between January 1, 2016 and January 31, 2019, were prospectively followed. The management of E. faecalis BSI was evaluated in terms of adherence to evidence-based quality-of-care indicators (QCIs). IDC and other factors potentially associated with 90-day-mortality or relapse of E. faecalis BSI were analyzed by multivariate logistic regression. Results A total of 151 patients with a median age of 68 years were studied. IDC was performed in 38% of patients with E. faecalis BSI. 30 cases of endocarditis (20%) were diagnosed. All-cause in-hospital mortality was 23%, 90-day mortality was 37%, and 90-day relapsing E. faecalis BSI was 8%. IDC was significantly associated with better adherence to 5 QCIs. Factors significantly associated with 90-day mortality or relapsing EfB in multivariate analysis were severe sepsis or septic shock at onset (HR 4.32, CI 2.36e7.88) and deep-seated focus of infection (superficial focus HR 0.33, CI 0.14e0.76). Conclusion Enterococcus faecalis bacteremia is associated with a high mortality. IDC contributed to improved diagnostic and therapeutic management.

Prevalence and Antibiotic Susceptibility Trends of Selected Enterobacteriaceae, Enterococci, and Candida albicans in the Subgingival Microbiota of German Periodontitis Patients: A Retrospective Surveillance Study

“…Enterococci, for example, are considered as transient constituent components of the oral microbiome and it is well known that they can cause or contribute to a variety of oral and systemic infections including urinary tract, blood stream, and wound infections, or endocarditis [2][3][4][5]. They have also been recognized as nosocomial pathogens, mainly due to the increasing emergence of antimicrobial resistance phenotypes [6,7] and their capacity to form biofilms.…”

Impact of Infectious Diseases Consultation on the Outcome of Patients With Enterococcal Bacteremia: A Systematic Literature Review and Meta-analysis

“…After screening by title and abstracts, 204 full-text articles were evaluated, including an additional 2 studies that were added after screening the references of the articles. A total of 18 articles were included for our systemic literature review [ 23–25 , 27–41 ] ( Table 1 ). Two articles [ 31 , 38 ] were later excluded due to incomplete data for the meta-analysis, leaving 16 studies for the meta-analysis [ 23–25 , 27–30 , 32–37 , 39–41 ].…”

“…A total of 18 articles were included for our systemic literature review [ 23–25 , 27–41 ] ( Table 1 ). Two articles [ 31 , 38 ] were later excluded due to incomplete data for the meta-analysis, leaving 16 studies for the meta-analysis [ 23–25 , 27–30 , 32–37 , 39–41 ].…”

“…Of the 18 included studies, 14 (78%) were retrospective cohort studies [ 24 , 25 , 27–30 , 32 , 33 , 35–39 , 41 ], 2 (11%) were prospective cohort studies [ 23 , 40 ], and 2 (11%) were quasi-experimental studies [ 31 , 34 ]. Thirteen (72%) were performed at a single academic center [ 23–25 , 27 , 30–34 , 36–41 ], 1 study was performed at 2 academic centers [ 29 ], another study was performed at 99 Veteran Affairs hospitals [ 28 ], and the other study was performed at 2 community hospitals [ 35 ]. Two were performed at the same academic center [ 24 , 36 ].…”

“…The following data were collected as available: study design, study period, population characteristics, source of enterococci, percentage of VRE, the proportion of echocardiograms performed, and mortality. Nine authors were contacted for additional information, and 3 were able to provide additional information regarding the number of patients who died with and without IDC [ 23–25 ]. Any discordance was mediated by a fourth independent reviewer (H.S.)…”