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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)...
Summary
SUMMARY

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.

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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: Dr.McKinnell@yahoo.com)
References
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Epidemiology & Infection
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