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Risk Factors and Outcomes Associated With Non–Enterococcus faecalis, Non–Enterococcus faecium Enterococcal Bacteremia

  • Marie A. de Perio (a1), Paul R. Yarnold (a2), John Warren (a3) and Gary A. Noskin (a4)



To compare risk factors, clinical features, and outcomes in patients with Enterococcus avium, Enterococcus casseliflavus, Enterococcus durans, Enterococcus gallinarum, and Enterococcus mundtii bacteremia (cases) with those in patients with Enterococcus faecalis bacteremia (controls).


A retrospective case-control study.


A 725-bed, university-affiliated, academic medical center.


The clinical microbiology database at Northwestern Memorial Hospital from January 1994 to May 2003 was searched to identify cases; each case was matched to one control on the basis of date of admission.


Thirty-three cases were identified and matched with 33 controls. The mean duration of hospital stay was longer (29.7 vs 17.2 days; P = .03) and the mean time to acquisition of bacteremia was greater (16.5 vs 6.3 days; P = .003) for cases than controls. Cases were more likely to have underlying hematologic malignancies (P < .001), to have been treated with corticosteroids (P = .02), and to be neutropenic (P = .003). Controls were more likely to have an indwelling bladder catheter (P = .01), and cases were more likely to have the gastrointestinal tract as a source of infection (P = .007) and to have concurrent cholangitis (P = .002). There were no differences in severity of illness or in mortality rates.


Compared with patients with E. faecalis bacteremia, patients with non-E. faecalis, non-Enterococcus faecium enterococcal bacteremia were more likely to have a hematologic malignancy, prior treatment with corticosteroids, neutropenia, and cholangitis; longer duration of hospital stay was also identified as a clinical feature. However, non-E. faecalis, non-E. faecium species are not associated with any differences in mortality.


Corresponding author

Feinberg School of Medicine, Northwestern University, 251 East Huron Street, Gaiter 3-210, Chicago, IL 60611 (


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1.Moellering, RC Jr. Vancomycin-resistant enterococci. Clin Infect Dis 1998; 26:11961199.
2.Johnson, AP. The pathogenicity of enterococci. J Antimicrob Chemother 1994; 33:10831089.
3.Maki, DG, Agger, WA. Enterococcal bacteremia: clinical features, the risk of endocarditis, and management. Medicine (Baltimore) 1988; 67:248269.
4.Murray, BE. The life and times of the enterococcus. Clin Microbiol Rev 1990; 3:4665.
5.Weinstein, MP, Towns, ML, Quartey, SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997; 24:584602.
6.National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990 to May 1999, issued June 1999. Am J Infect Control 1999; 27:520532.
7.Edmond, MB, Wallace, SE, McClish, DK, et al. Nosocomial bloodstream infections in United States hospitals: a three year analysis. Clin Infect Dis 1999; 29:239244.
8.Noskin, GA, Till, M, Patterson, BK, Clarke, JT, Warren, JR. High-level gentamicin resistance in Enterococcus faecalis bacteremia. J Infect Dis 1991;164:12121215.
9.Gray, J, Marsh, PJ, Stewart, D, Pedler, SJ. Enterococcal bacteremia: a prospective study of 125 episodes. J Hosp Infect 1994; 27:179186.
10.Patterson, JE, Sweeney, AH, Simms, M, et al. An analysis of 110 serious enterococcal infections. Epidemiology, antibiotic susceptibility, and outcome. Medicine (Baltimore) 1995; 74:191200.
11.Noskin, GA, Peterson, LR, Warren, JR. Enterococcus faecium and Enterococcus faecalis bacteremia: acquisition and outcome. Clin Infect Dis 1995; 20:296301.
12.Vergis, EN, Hayden, MK, Chow, JW, et al. Determinants of vancomycin resistance and mortality rates in enterococcal bacteremia: a prospective multicenter study. Ann Intern Med 2001; 135:484492.
13.Bone, RC, Balk, RA, Cerra, FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992; 101:16441655.
14.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13:818829.
15.Facklam, RR, Collins, MD. Identification of enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol 1989; 27:731734.
16.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimocrobial Susceptibility Testing for Bacteria that Grow Aerobically, ed. 6. Villanova, Pa: National Committee for Clinical Laboratory Standards; 2004, NCCLS document M7-A6.
17.Reid, KC, Franklin, RC, Patel, R. Clinical and epidemiological features of Enterococcus casseliflavus/flavescens and Enterococcus gallinarum bacteremia: a report of 20 cases. Clin Infect Dis 2001; 32:15401546.
18.Choi, SH, Lee, SO, Kim, TH, et al. Clinical features and outcomes of bacteremia caused by Enterococcus casseliflavus, and Enterococcus gallinarum: analysis of 56 cases. Clin Infect Dis 2004; 38:5361.
19.Toye, B, Shymanski, J, Bobrowska, M, et al. Clinical and epidemiologic significance of enterococci intrinsically resistant to vancomycin (possessing the vanC genotype). J Clin Microbiol 1997; 35:31663170.
20.Leclercq, R, Dutka-Malen, S, Duval, J, et al. Vancomycin resistance gene vanC is specific to Enterococcus gallinarum. Antimicrob Agents Chemother 1992; 36:20052008.
21.Patel, R, Uhl, JR, Kohner, P, et al. Multiplex PCR detection of vanA, vanB, vanC-1, and van C-2/3 genes in enterococci. J Clin Microbiol 1997; 35: 703707.
22.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128140.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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