Skip to main content
    • Aa
    • Aa

Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents

  • J. A. McKINNELL (a1) (a2), M. PATEL (a3) (a4), R. M. SHIRLEY (a3), D. F. KUNZ (a5), S. A. MOSER (a6) and J. W. BADDLEY (a3) (a4)...

Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSI) are a growing problem with few clinical trials to guide therapy. We conducted a retrospective study of management and predictors of mortality for VRE-BSI at a tertiary-care centre from January 2005 to August 2008. Univariate and multivariable analyses examined the relationship of patient characteristics and antibiotic therapy with 30-day all-cause mortality. Rates of VRE-BSI increased from 0·06 to 0·17 infections/1000 patient-days (P=0·03). For 235 patients, 30-day mortality was 34·9%. Patients were primarily treated with linezolid (44·2%) or daptomycin (36·5%). Factors associated with mortality were haemodialysis [odds ratio (OR) 3·2, 95% confidence interval (CI) 1·6–6·3, P=0·007], mechanical ventilation (OR 3·7, 95% CI 1·3–10·4, P=0·01), and malnutrition (OR 2·0, 95% CI 1·0–4·0, P=0·046). Use of linezolid, but not daptomycin (P=0·052) showed a trend towards an association with survival. In conclusion, VRE-BSI is a growing problem, associated with significant 30-day mortality. Multiple factors were associated with poor outcomes at our hospital.

Corresponding author
*Author for correspondence: J. A. McKinnell, M.D., Los Angeles Biomedical Research Institute, Division of Infectious Diseases, 1124 West Carson Street, Torrance, CA 90502, USA. (Email:
Hide All
1.Hidron AI, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infection Control and Hospital Epidemiology 2008; 29: 996–1011.
2.Deshpande LM, et al. Antimicrobial resistance and molecular epidemiology of vancomycin-resistant enterococci from North America and Europe: a report from the SENTRY antimicrobial surveillance program. Diagnostic Microbiology and Infectious Diseases 2007; 58: 163170.
3.NNIS System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. American Journal of Infection Control 2004; 32: 470485.
4.Vergis EN, et al. Determinants of vancomycin resistance and mortality rates in enterococcal bacteremia: a prospective multicenter study. Annals of Internal Medicine 2001; 135: 484492.
5.Erlandson KM, et al. Impact of the more-potent antibiotics quinupristin-dalfopristin and linezolid on outcome measure of patients with vancomycin-resistant Enterococcus bacteremia. Clinical Infectious Diseases 2008; 46: 3036.
6.DiazGranados CA, Jernigan JA. Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection. Journal of Infectious Diseases 2005; 191: 588595.
7.Gearhart M, et al. Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study. Clinical Transplantation 2005; 19: 711716.
8.Garbutt JM, et al. Association between resistance to vancomycin and death in cases of Enterococcus faecium bacteremia. Clinical Infectious Diseases 2000; 30: 466472.
9.Song JH, et al. Clinical implications of vancomycin-resistant Enterococcus faecium (VRE) with VanD phenotype and vanA genotype. Journal of Antimicrobial Chemotherapy 2008; 61: 838844.
10.Song X, et al. Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs. Infection Control and Hospital Epidemiology 2003; 24: 251256.
11.Papanicolaou GA, et al. Nosocomial infections with vancomycin-resistant Enterococcus faecium in liver transplant recipients: risk factors for acquisition and mortality. Clinical Infectious Diseases 1996; 23: 760766.
12.DiazGranados CA, et al. Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clinical Infectious Diseases 2005; 41: 327333.
13.Warren RE. Daptomycin in endocarditis and bacteraemia: a British perspective. Journal of Antimicrobial Chemotherapy 2008; 62 (Suppl. 3): 2533.
14.Schwartz BS, Ngo PD, Guglielmo BJ. Daptomycin treatment failure for vancomycin-resistant Enterococcus faecium infective endocarditis: impact of protein binding? Annals of Pharmacotherapy 2008; 42: 289290.
15.Mohr JF, et al. Daptomycin for the treatment of enterococcal bacteraemia: results from the Cubicin Outcomes Registry and Experience (CORE). International Journal of Antimicrobial Agents 2009; 33: 543548.
16.Mave V, et al. Vancomycin-resistant enterococcal bacteraemia: is daptomycin as effective as linezolid? Journal of Antimicrobial Chemotherapy 2009; 64: 175180.
17.Camins BC, et al. A population-based investigation of invasive vancomycin-resistant Enterococcus infection in metropolitan Atlanta, Georgia, and predictors of mortality. Infection Control and Hospital Epidemiology 2007; 28: 983991.
18.Bhavnani SM, et al. A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagnostic Microbiology and Infectious Diseases 2000; 36: 145158.
19.Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control 2008; 36: 309332.
20.Charlson ME, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 1987; 40: 373383.
21.Boucher HW, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clinical Infectious Diseases 2009; 48: 112.
22.Reik R, et al. The burden of vancomycin-resistant enterococcal infections in US hospitals, 2003 to 2004. Diagnostic Microbiology and Infectious Diseases 2008; 62: 8185.
23.Ghanem G, et al. Outcomes for and risk factors associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant Enterococcus faecium bacteremia in cancer patients. Infection Control and Hospital Epidemiology 2007; 28: 10541059.
24.Poutsiaka DD, et al. Daptomycin in the treatment of vancomycin-resistant Enterococcus faecium bacteremia in neutropenic patients. Journal of Infection 2007; 54: 567571.
25.Segreti JA, Crank CW, Finney MS. Daptomycin for the treatment of gram-positive bacteremia and infective endocarditis: a retrospective case series of 31 patients. Pharmacotherapy 2006; 26: 347–332.
26.Raad II, et al. Vancomycin-resistant Enterococcus faecium: catheter colonization, esp gene, and decreased susceptibility to antibiotics in biofilm. Antimicrobial Agents and Chemotherapy 2005; 49: 50465050.
27.Moellering RC, et al. The efficacy and safety of quinupristin/dalfopristin for the treatment of infections caused by vancomycin-resistant Enterococcus faecium. Synercid Emergency-Use Study Group. Journal of Antimicrobial Chemotherapy 1999; 44: 251261.
28.Kvirikadze N, et al. Daptomycin for the treatment of vancomycin resistant Enterococcus faecium bacteremia. Scandinavian Journal of Infectious Diseases 2006; 38: 290292.
29.Cunha BA, Mickail N, Eisenstein L. E. faecalis vancomycin-sensitive enterococcal bacteremia unresponsive to a vancomycin tolerant strain successfully treated with high-dose daptomycin. Heart and Lung 2007; 36: 456461.
30.Levine DP. Clinical experience with daptomycin: bacteraemia and endocarditis. Journal of Antimicrobial Chemotherapy 2008; 62 (Suppl. 3): 3539.
31.Chien JW, Kucia ML, Salata RA. Use of linezolid, an oxazolidinone, in the treatment of multidrug-resistant gram-positive bacterial infections. Clinical Infectious Diseases 2000; 30: 146151.
32.Fowler VG Jr., et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clinical Infectious Diseases 1998; 27: 478486.
33.Patel M, et al. Initial management of candidemia at an academic medical center: evaluation of the IDSA guidelines. Diagnostic Microbiology and Infectious Diseases 2005; 52: 2934.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 1
Total number of PDF views: 16 *
Loading metrics...

Abstract views

Total abstract views: 167 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th October 2017. This data will be updated every 24 hours.