Table 1.
Characteristics of Patients With Bloodstream Infections due to Enterococci
| Variables | VSE(n = 176) | VRE(n = 56) | Total Population (N = 232) | P Value |
|---|---|---|---|---|
| Demographics | ||||
| Age, y, median (IQR) | 66 (57.4–74.60) | 59 (51.4–66.60) | 64 (53–71) | .011 |
| Sex, male | 107 (60.80) | 29 (51.79) | 136 (58.62) | |
| Current admission | ||||
| Intensive care unit admission | 41 (23.30) | 23 (41.07) | 64 (27.59) | .009 |
| Reason of admission—medical | 166 (94.32) | 51 (91.07) | 217 (93.53) | |
| Length of hospitalization, d, median (IQR)a | 13 (3–23) | 25 (13.1–36.9) | 14 (8–31.5) | <.001 |
| Medical history | ||||
| Baseline comorbidities | ||||
| Heart/cardiovascular diseaseb | 78 (44.32) | 19 (33.93) | 97 (41.81) | |
| Diabetes mellitus | 60 (34.09) | 21 (37.50) | 81 (34.91) | |
| Chronic obstructive pulmonary disease | 19 (10.80) | 4 (7.14) | 23 (9.91) | |
| Chronic kidney disease | 34 (19.32) | 11 (19.64) | 45 (19.40) | |
| Liver disease | 12 (6.82) | 6 (10.71) | 18 (7.76) | |
| Solid malignancy | 52 (29.55) | 7 (12.50) | 59 (25.43) | |
| Hematological malignancy | 57 (32.39) | 30 (53.57) | 87 (37.50) | .004 |
| Charlson Comorbidity Index, median (IQR) | 4 (3–5.5) | 4 (3–5) | 4 (3–6) | |
| Solid organ transplant | 4 (2.27) | 4 (7.14) | 8 (3.45) | .098 |
| Bone marrow transplant | 17 (9.66) | 14 (25) | 31 (13.36) | .003 |
| Immunosuppressive therapy | 70 (39.77) | 23 (41.07) | 93 (40.09) | |
| Cardiac device and cardiac valve | 26 (14.77) | 5 (8.93) | 31 (13.36) | |
| Hemodialysis | 26 (14.77) | 11 (19.64) | 37 (15.95) | |
| Previous hospitalization within 1 y | 121 (68.75) | 50 (89.29) | 171 (73.71) | .002 |
| Nursing home/long-term facility | 12 (6.82) | 4 (7.14) | 16 (6.90) | |
| Microbiological failurec | 27 (15.34) | 12 (21.43) | 39 (16.81) | |
| Recurrent BSId | 7 (3.98) | 8 (14.29) | 15 (6.47) | .005 |
| At the time of blood culture collection | ||||
| Recent surgical procedure | 11 (6.25) | 5 (8.93) | 16 (6.90) | |
| Steroid use | 21 (11.93) | 14 (25) | 35 (15.09) | .017 |
| Neutropenia, defined as <500 cells/µL | 42 (23.86) | 27 (48.21) | 69 (29.74) | .001 |
| Central line placement | 83 (47.16) | 44 (78.57) | 127 (54.74) | |
| Urinary catheter | 35 (19.89) | 18 (32.14) | 53 (22.84) | .057 |
| Mechanical ventilation | 16 (9.09) | 12 (21.43) | 28 (12.07) | .014 |
| Pitt bacteremia score ≥2 | 73 (41.48) | 23 (41.07) | 96 (41.38) | |
| Index BSI episode | ||||
| Polymicrobial BSIe | 43 (24.43) | 13 (23.21) | 56 (24.14) | |
| Enterococcus faecium | 36 (20.45) | 50 (89.29) | 86 (37.07) | <.001 |
| Enterococcus faecalis | 140 (79.55) | 6 (10.71) | 146 (62.93) | <.001 |
| Infectious diseases consult | 146 (82.95) | 50 (89.29) | 196 (84.48) | |
| Endocarditis | 15 (8.52) | 4 (7.14) | 19 (8.19) | |
| Subjects with echocardiogram | 87 (49.43) | 28 (50.00) | 115 (49.57) | |
| Both (transthoracic and transesophageal) | 1 (1.15) | 5 (17.86) | 6 (5.22) | .015 |
| Duration of anti-enterococcal therapy, d (days)f | 10 (7–15) | 12 (6–17.2) | 10 (6.75–15) | |
| Infection source | ||||
| Central line infection | 39 (22.16) | 17 (30.36) | 56 (24.14) | |
| Genitourinary | 25 (14.20) | 3 (5.36) | 28 (12.07) | .099 |
| Abdominal/gastrointestinal | 46 (26.14) | 11 (19.64) | 57 (24.57) | |
| Unknown/primary source | 63 (35.80) | 21 (37.50) | 84 (36.21) | |
| Wound/osteoarticular | 3 (1.70) | 4 (7.14) | 7 (3.02) | |
| Definitive antimicrobial therapyg | ||||
| Monotherapy | 110 (62.50) | 35 (62.50) | 145 (62.50) | |
| β-lactamsh | 47 (26.70) | 6 (10.71) | 53 (22.84) | .007 |
| Daptomycin | 30 (17.05) | 23 (41.07) | 53 (22.84) | <.001 |
| Daptomycin dose, mg/kg, median (IQR) | 8 (6–8) | 8 (8–10) | 8 (6–10) | .045 |
| Daptomycin ≥10 mg/kg | 6 (20) | 9 (39.13) | 15 (28.30) | |
| Vancomycin | 30 (17.05) | 2 (3.57) | 32 (13.79) | |
| Linezolid | 2 (1.14) | 4 (7.14) | 6 (2.59) | .031 |
| Tigecycline | 1 (0.57) | 0 | 1 (0.43) | |
| Combination therapy | 55 (31.25) | 14 (25) | 69 (29.74) | |
| Dual β-lactamsh | 15 (8.52) | 2 (3.57) | 17 (7.33) | |
| Gentamicin plus β-lactamsh | 9 (5.11) | 0 | 9 (3.88) | .084 |
| Vancomycin plus β-lactamsh | 9 (5.11) | 0 | 9 (3.88) | .05 |
| Daptomycin plus β-lactamsh | 8 (4.55) | 4 (7.14) | 12 (5.17) | |
| Daptomycin plus linezolid | 4 (2.27) | 4 (7.14) | 8 (3.45) | .098 |
| Otheri | 10 (5.68) | 4 (7.14) | 14 (6.03) | |
| Daptomycin dose, mg/kg, median (IQR) | 8 (8–10) | 8 (8–8) | 8 (8–10) | |
| Empirical therapyj | 138 (78.41) | 47 (83.93) | 185 (79.74) | |
| Vancomycin | 74 (42.05) | 18 (32.14) | 92 (39.66) | |
| β-lactamsh | 71 (40.34) | 19 (33.93) | 90 (38.79) | |
| Daptomycin | 27 (15.34) | 24 (42.86) | 51 (21.98) | <.001 |
| Linezolid | 23 (13.07) | 11 (19.64) | 34 (14.66) | |
| Tigecycline | 3 (1.70) | 4 (7.14) | 7 (3.02) | |
| Clinical outcomes | ||||
| In-hospital mortality | 22 (12.50) | 20 (35.71) | 42 (18.10) | <.001 |
Data are presented as No. (%) unless otherwise indicated.
Abbreviations: BSI, bloodstream infection; IQR, interquartile range; VRE, vancomycin-resistant enterococci; VSE, vancomycin-susceptible enterococci.
Total days of hospitalization, including days before and after treatment of enterococcal bacteremia.
Categories of heart/cardiovascular diseases are not mutually exclusive. Conditions include ischemic heart disease, cerebrovascular disease, chronic heart failure, and peripheral vascular disease.
Microbiological failure was defined as lack of clearance of BSI after ≥4 days of the index blood culture, while receiving at least 48 hours of active antibiotic therapy.
Recurrent BSI was defined as the presence of a new positive enterococcal blood culture in a patient who had previous negative blood culture.
Polymicrobial BSI was defined as the presence of ≥1 bacterial species other than enterococci in the same blood culture.
Including empiric and definitive therapy.
Definitive enterococcal therapy was defined as a drug with in vitro activity against the enterococcal isolate recovered from the bloodstream of the individual (after release of antibiotic susceptibility results).
β-lactams include ampicillin, ampicillin-sulbactam, amoxicillin-clavulanic acid, ceftriaxone, or piperacillin-tazobactam.
Others include linezolid plus β-lactams (n = 6), daptomycin plus vancomycin (n = 2), tigecycline plus β-lactams (n = 2), gentamicin plus vancomycin (n = 1), daptomycin plus quinupristin-dalfopristin (n = 1), and daptomycin plus tigecycline (n = 2).
Defined as antibiotics given before antimicrobial susceptibility was available.