Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital

Abstract

The incidence of bacteremia caused by Enterococcus faecium, which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of E. faecium infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiological, and clinical characteristics using a Cox regression model and univariate analysis. We performed a multivariate analysis to identify risk factors for patients treated between 2014 and 2018. Among 186 patients with enterococcal bacteremia, two groups included in the Kaplan–Meier analysis (E. faecalis (n = 88) and E. faecium (n = 94)) showed poor overall survival in the E. faecium group (HR: 1.92; 95% confidence interval: 1.01–3.66; p = 0.048). The median daily antibiotic cost per patient in the E. faecium group was significantly higher than that in the E. faecalis group ($23 ($13–$34) vs. $34 ($22–$58), p < 0.001). E. faecium strains were more frequently identified with previous use of antipseudomonal penicillins (OR = 4.04, p < 0.001) and carbapenems (OR = 3.33, p = 0.003). Bacteremia from an unknown source (OR = 2.79, p = 0.025) and acute kidney injury (OR = 4.51, p = 0.004) were associated with higher risks of 30-day mortality in patients with enterococcal bacteremia. Therefore, clinicians should provide improved medical management, with support from specialized teams such as those assisting antimicrobial stewardship programs.

Risk Factors and Predictive Score for Bacteremic Biliary Tract Infections Due to Enterococcus faecalis and Enterococcus faecium: a Multicenter Cohort Study from the PROBAC Project

“…Chronic kidney disease has been described as a risk factor for enterococcal BSI in several studies, even if not focusing on BT-BSI ( 12 , 13 ). Finally, the use of carbapenems is a well-recognized risk factors for enterococcal bacteremia, and particularly for E. faecium ( 14 – 16 ).…”

Comparative Effectiveness of Ampicillin/Sulbactam versus Cefazolin as Targeted Therapy for Bacteremia Caused by Beta-Lactamase-Producing Methicillin-Sensitive Staphylococcus aureus: A Single-Center Retrospective Study

“…Furthermore, AST physicians follow the clinical course to determine whether a patient’s condition worsens after de-escalation. Although prior studies revealed that the administration of alternative broad-spectrum drugs is associated with worse clinical outcomes [ 18 , 19 ], we could avoid worse deterioration in patient outcomes even in an antimicrobial shortage period. Moreover, based on a multivariate analysis, Uda et al, reported that administration of broad-spectrum antibiotics, such as piperacillin/tazobactam, as definitive therapy was associated with treatment failure in patients with MSSA bacteremia during the CFZ shortage period (odds ratio = 17, p = 0.003) [ 20 ].…”

Assessing clinical outcomes of vancomycin treatment in adult patients with penicillin-resistant Enterococcus faecium bacteremia

“…Moreover, a study predicting the risk of VCM-induced acute kidney injury (AKI) reported that 32 (36.8%) of 87 patients who received vasopressors developed AKI and were being treated [14]. The development of AKI is thought to increase the risk of death from an enterococcal bloodstream invasion [15].…”