Skip to main content Accessibility help

Outcomes for and Risk Factors Associated With Vancomycin-Resistant Enterococcus faecalis and Vancomycin-Resistant Enterococcus faecium Bacteremia in Cancer Patients

  • G. Ghanem (a1), R. Hachem (a1), Y. Jiang (a1), R. F. Chemaly (a1) and I. Raad (a1)...



Vancomycin-resistant enterococci (VRE) are a major cause of nosocomial infection. We sought to compare vancomycin-resistant (VR) Enterococcus faecalis bacteremia and VR Enterococcus faecium bacteremia in cancer patients with respect to risk factors, clinical presentation, microbiological characteristics, antimicrobial therapy, and outcomes.


We identified 210 cancer patients with VRE bacteremia who had been treated between January 1996 and December 2004; 16 of these 210 had VR E. faecalis bacteremia and were matched with 32 patients with VR E. faecium bacteremia and 32 control patients. A retrospective review of medical records was conducted.


Logistic regression analysis showed that, compared with VR E. faecalis bacteremia, VR E. faecium bacteremia was associated with a worse clinical response to therapy (odds ratio [OR], 0.3 [95% confidence interval (CI), 0.07-0.98]; P = .046) and a higher overall mortality rate (OR, 8.3 [95% CI, 1.9-35.3]; P = .004), but the VRE-related mortality rate did not show a statistically significant difference (OR, 6.8 [95% CI, 0.7-61.8]; P = .09). Compared with control patients, patients with VR E. faecalis bacteremia were more likely to have received an aminoglycoside in the 30 days before the onset of bacteremia (OR, 5.8 [95% CI, 1.2-27.6]; P = .03), whereas patients with VR E. faecium bacteremia were more likely to have received a carbapenem in the 30 days before the onset of bacteremia (OR, 11.7 [95% CI, 3.6-38.6]; P<.001). In a multivariate model that compared patients with VR E. faecium bacteremia and control patients, predictors of mortality included acute renal failure on presentation (OR, 15.1 [95% CI, 2.3-99.2]; P = .004) and VR E. faecium bacteremia (OR, 11 [95% CI, 2.7-45.1]; P<.001). No difference in outcomes was found between patients with VR E. faecalis bacteremia and control patients.


VR E. faecium bacteremia in cancer patients was associated with a poorer outcome than was VR E. faecalis bacteremia. Recent receipt of carbapenem therapy was an independent risk factor for VR E. faecium bacteremia, and recent receipt of aminoglycoside therapy was independent risk factor for E. faecalis bacteremia.


Corresponding author

Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 402, Houston, TX 77030 (


Hide All
1. Leclercq, R, Derlot, E, Duval, J, et al. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faeciutn . N Engl J Med 1988;319:157161.
2. Sahm, DF, Kissinger, J, Gilmore, MS, et al. In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis . Antimicrob Agents Chemother 1989;33:15881591.
3. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992–June 2001, issued August 2001. Am J Infect Control 2001;29:404421.
4. Carmeli, Y, Eliopoulos, G, Mozaffari, E, et al. Health and economic outcomes of vancomycin-resistant enterococci. Arch Intern Med 2002;162:22232238.
5. Hsueh, PR, Chen, WH, Teng, LJ, et al. Nosocomial infections due to methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci at a university hospital in Taiwan from 1991 to 2003: resistance trends, antibiotic usage and in vitro activities of newer antimicrobial agents. Int J Antimicrob Agents 2005;26:4349.
6. Scagnelli, M, Pellizer, G, de Lalla, F, et al. Epidemiological analysis of vancomycin-resistant enterococci in a large tertiary-care hospital in Northern Italy. Eur J Clin Microbiol Infect Dis 2001;20:609616.
7. Wong, AH, Wenzel, RP, Edmond, MB. Epidemiology of bacteriuria caused by vancomycin-resistant enterococci: a retrospective study. Am J Infect Control 2000;28:277281.
8. Schouten, MA, Voss, A, Hoogkamp-Korstanje, JA; The European VRE Study Group. Antimicrobial susceptibility patterns of enterococci causing infections in Europe. Antimicrob Agents Chemother 1999;43:25422546.
9. Edmond, MB, Ober, JF, Dawson, JD, et al. Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin Infect Dis 1996;23:12341239.
10. Linden, PK, Pasculle, AW, Manez, R, et al. Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E. faecium . Clin Infect Dis 1996;22:663670.
11. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864874.
12. Shankar, N, Baghdayan, AS, Gilmore, MS. Modulation of virulence within a pathogenicity island in vancomycin-resistant Enterococcus faecalis . Nature 2002;417:746750.
13. Tendolkar, PM, Baghdayan, AS, Shankar, N. Pathogenic enterococci: new developments in the 21st century. Cell Mol Life Sci 2003;60:26222636.
14. Liornese, LL, Dias, S, Samel, C, Romanowski, B, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112116.
15. Zirakzadeh, A, Patel, R. Vancomycin-resistant enterococci: colonization, infection, detection, and treatment. Mayo Clin Proc 2006;81:529536.
16. Hayden, MK, Bonten, MJ, Blom, DW, et al. Reduction in acquisition of vancomycin-resistant Enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006;42:15521560.
17. Martinez, JA, Rufhazer, R, Hansjosten, K, et al. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med 2003;163:19051912.
18. Chavers, LS, Moser, SA, Funkhouser, E et al. Association between antecedent intravenous antimicrobial exposure and isolation of vancomycin-resistant enterococci. Microb Drug Resist 2003;9(suppl 1):S69S77.
19. Suntharam, N, Lankford, MG, Trick, WE, et al. Risk factors for acquisition of vancomycin-resistant enterococci among hematology-oncology patients. Diagn Microbiol Infect Dis 2002;43:183188.
20. Carmeli, Y, Samore, MH, Huskins, C. The association between antecedent vancomycin treatment and hospital-acquired vancomycin-resistant enterococci: a meta-analysis. Arch Intern Med 1999;159:24612468.
21. Furtado, GH, Mendes, RE, Pignatari, AC, et al. Risk factors for vancomycin-resistant Enterococcus faecalis bacteremia in hospitalized patients: an analysis of two case-control studies. Am J Infect Control 2006;34:447451.
22. Noskin, GA, Peterson, LR, Warren, JR. Enterococcus faecium and enterococcus faecalis bacteremia: acquisition and outcome. Clin Infect Dis 1995;20:296301.
23. Jones, RN, Sader, HS, Erwin, ME, et al.; Enterococcus Study Group. Emerging multiply-resistant enterococci among clinical isolates: prevalence data from 97-medical center surveillance study in the United States. Diagn Microbiol Infect Dis 1995;21:8593.
24. Eliopoulos, GM, Wennersten, C, Zighelboim-Daum, S, et al. High-level resistance to gentamicin in clinical isolates of Streptococcus (Enterococcus) faecium . Antimicrob Agents Chemother 1988;32:15281532.
25. Jett, BD, Huycke, MM, Gilmore, MS. Virulence of enterococci. Clin Microbiol Rev 1994;7:462478.
26. Vanholder, R, De Smet, R, Jacobs, V, et al. Uraemic toxic retention solutes depress polymorphonuclear response to phagocytosis. Nephrol Dial Transplant 1994;9:12711278.
27. Willems, RJL, Top, J, Van Santen, M, et al. Global spread of vancomycin-resistant Enterococcus faecium from distinct nosocomial genetic complex. Emerg Infect Dis 2005;11:821828.
Recommend this journal

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

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed