Abstract
PurposeTo evaluate the relationship between mortality or relapse of bloodstream infection (BSI) due to Enterococcus faecalis and infectious diseases specialist consultation (IDC) and other factors potentially associated with outcomes.MethodsIn a tertiary-care center, consecutive adult patients with E. faecalis BSI between January 1, 2016 and January 31, 2019, were prospectively followed. The management of E. faecalis BSI was evaluated in terms of adherence to evidence-based quality-of-care indicators (QCIs). IDC and other factors potentially associated with 90-day-mortality or relapse of E. faecalis BSI were analyzed by multivariate logistic regression.ResultsA total of 151 patients with a median age of 68 years were studied. IDC was performed in 38% of patients with E. faecalis BSI. 30 cases of endocarditis (20%) were diagnosed. All-cause in-hospital mortality was 23%, 90-day mortality was 37%, and 90-day relapsing E. faecalis BSI was 8%. IDC was significantly associated with better adherence to 5 QCIs. Factors significantly associated with 90-day mortality or relapsing EfB in multivariate analysis were severe sepsis or septic shock at onset (HR 4.32, CI 2.36e7.88) and deep-seated focus of infection (superficial focus HR 0.33, CI 0.14e0.76).ConclusionEnterococcus faecalis bacteremia is associated with a high mortality. IDC contributed to improved diagnostic and therapeutic management.
Highlights
Enterococcus spp. are important causes of both communityand hospital-acquired bloodstream infections and account for 10% of endocarditis cases worldwide [1]
To evaluate the impact of infectious diseases specialist consultation (IDC) on the management of E. faecalis BSI (EfB), we identified five evidence-based quality-of-care indicators (QCIs) based on clinical experience and extrapolated from the literature [14, 15, 18], which were defined according to Table 1
We focused on management of E. faecalis bacteremia, and we evaluated the impact of IDC in terms of quality of diagnostic work-up, quality of therapy, and outcome
Summary
Enterococcus spp. are important causes of both communityand hospital-acquired bloodstream infections and account for 10% of endocarditis cases worldwide [1]. Incidence of E. faecalis BSI (EfB) has been estimated to be ~ 4.5 per 100,000 annually and case fatality between 10 and 20% [2, 3]. EfB has been described as a clinical entity with different risk factors, clinical features, and microbiological characteristics than other enterococcal BSIs [2]. The optimal management of E. faecalis invasive infections is still not clearly defined and data concerning the risk of developing endocarditis are divergent. Dahl et al found that infective endocarditis (IE) was diagnosed 1 out of 4 patients with EfB who systematically received echocardiography [4]
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