Enterococcus faecium bacteremia: Does vancomycin resistance make a difference?

Valentina Stosor*, Lance R. Peterson, Michael Postelnick, Gary A. Noskin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

163 Scopus citations

Abstract

Background: Enterococcus faecium has received increased attention, primarily due to the emergence of vancomycin resistance. The purpose of this investigation was to study the epidemiological characteristics of vancomycin-resistant E faecium (VRE) bacteremia and to determine the clinical impact of vancomycin resistance on the outcome of patients with this infection. Methods: We retrospectively analyzed the clinical features and outcome of 53 patients with E faecium bacteremia. Results: From January 1992 until December 1995, there were 32 episodes of bacteremia caused by vancomycin-susceptible E faecium (VSE) and 21 caused by VRE. An intra-abdominal site was the most common source of bacteremia in both groups. All of the VRE and 78% of VSE bacteremia cases were nosocomially acquired. Previous administration of vancomycin was associated with VRE bacteremia (P<.001), as were indwelling bladder catheters (P=.01). Fifty-nine percent of the patients with VSE bacteremia survived vs 24% with VRE (P=.009), despite similar severity-of-illness scores. In 62% of the patients with VRE sepsis, death was related to the bacteremia (P=.01). Patients infected with VRE had longer hospitalizations than those with VSE (34.8 vs 16.7 days, respectively) (P=.004), were more likely to be on the medical service (P=.03), and on the average, had hospitalization costs of more than $27000 per episode than did patients with VSE bloodstream infection ($83 897 vs $56 707, respectively) (P=.04). Conclusions: Vancomycin-resistant Efaecium bacteremia is a complication of prolonged hospitalization in debilitated patients. Vancomycin resistance has a negative impact on survival in patients with E faecium bacteremia and leads to higher health care costs.

Original languageEnglish (US)
Pages (from-to)522-527
Number of pages6
JournalArchives of Internal Medicine
Volume158
Issue number5
DOIs
StatePublished - Mar 9 1998

ASJC Scopus subject areas

  • Internal Medicine

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