Abstract
BackgroundEnterococcus spp. are the common cause of nosocomial bloodstream infections (BSIs) with high morbidity and mortality. The purpose of this study was to characterize the incidence, clinical and microbiological features, and mortality of nosocomial enterococcal BSIs at a large Chinese tertiary-care hospital in Beijing, China.MethodsA retrospective cohort study on adult patients with nosocomial BSIs due to Enterococcus spp. was performed between January 1, 2012, and December 31, 2015 at the Chinese People’s Liberation Army General Hospital. Patients’ data were gathered by reviewing electronic medical records.ResultsA total of 233 episodes of BSI due to Enterococcus spp. occurred among 224 patients during these 4 years. The overall incidence was 3.9 episodes per 10,000 admissions. Enterococcus faecium (E. faecium) was the major pathogen (74%, 95% CI 68–80%), followed by Enterococcus faecalis (E. faecalis) (20%, 95% CI 15–25%). E. faecium showed higher antimicrobial resistance than E. faecalis. The 30-day mortality of nosocomial enterococcal BSI was 24% (95% CI 18–29%). Predictors for mortality included the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), impaired renal function, prior use of immunosuppressive agents, and appropriate empirical antimicrobial treatment.ConclusionsThis study emphasizes that Enterococcus spp. were major pathogens for nosocomial BSIs and associated with high mortality. Appropriate empirical antimicrobial treatment can improve outcomes. Vancomycin is the best choice for patients with E. faecium BSIs. Penicillins, aminoglycosides, fluoroquinolones, and vancomycin can be considered for patients with E. faecalis BSIs.
Highlights
Enterococcus spp. are the common cause of nosocomial bloodstream infections (BSIs) with high morbidity and mortality
The median days of hospital stay prior to and Incidence and species distribution In total, 233 episodes of nosocomial BSIs caused by Enterococcus spp. occurred among 224 patients during the 4-year study period
This study focused on the incidence and characteristics of nosocomial enterococcal BSI in one of the biggest comprehensive hospitals in China
Summary
Enterococcus spp. are the common cause of nosocomial bloodstream infections (BSIs) with high morbidity and mortality. The purpose of this study was to characterize the incidence, clinical and microbiological features, and mortality of nosocomial enterococcal BSIs at a large Chinese tertiary-care hospital in Beijing, China. BSIs can cause high mortality and result in heavy social and economic burdens. A systematic review focused on community-acquired BSIs in south and southeast Asia showed that Enterococcus spp. were the third most prevalent gram positive bacteria [6]. The crude mortality rates of enterococcal BSIs ranged between 21.4% and 64.2% [7,8,9,10,11]. Risk factors for developing enterococcal BSIs include the presence of comorbidities such as malignancy, diabetes; more severe illness; invasive devices, such as a central intravenous catheter; complicated surgery; solid organ transplantation; and hematopoietic stem cell transplantation [2, 12,13,14,15,16]
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