Abstract
The incidence of bacteremia caused by Enterococcus faecium, which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of E. faecium infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiological, and clinical characteristics using a Cox regression model and univariate analysis. We performed a multivariate analysis to identify risk factors for patients treated between 2014 and 2018. Among 186 patients with enterococcal bacteremia, two groups included in the Kaplan–Meier analysis (E. faecalis (n = 88) and E. faecium (n = 94)) showed poor overall survival in the E. faecium group (HR: 1.92; 95% confidence interval: 1.01–3.66; p = 0.048). The median daily antibiotic cost per patient in the E. faecium group was significantly higher than that in the E. faecalis group ($23 ($13–$34) vs. $34 ($22–$58), p < 0.001). E. faecium strains were more frequently identified with previous use of antipseudomonal penicillins (OR = 4.04, p < 0.001) and carbapenems (OR = 3.33, p = 0.003). Bacteremia from an unknown source (OR = 2.79, p = 0.025) and acute kidney injury (OR = 4.51, p = 0.004) were associated with higher risks of 30-day mortality in patients with enterococcal bacteremia. Therefore, clinicians should provide improved medical management, with support from specialized teams such as those assisting antimicrobial stewardship programs.
Highlights
Enterococcus species are Gram-positive, facultative anaerobic cocci that constitute the normal bacterial flora in human and animal intestines
As few patients had bacteremia caused by E. avium, E. casseliflavus, E. raffinosus, and E. gallinarum, only the clinical characteristics of bacteremia with E. faecalis and E. faecium were further investigated among two subgroups
After excluding four cases of bacteremia caused by strains other than E. faecalis or E. faecium, 182 patients were eligible for inclusion in this study
Summary
Enterococcus species are Gram-positive, facultative anaerobic cocci that constitute the normal bacterial flora in human and animal intestines. Enterococcus faecalis, followed by E. faecium are the most frequent Enterococcal species that cause bacteremia [4]. Infections caused by vancomycin-resistant enterococci are associated with higher mortality and are a major problem in the United States and Western countries [3,5,6]. In the United States and Western countries, the enterococcal isolates of E. faecalis (80–90%) and E. faecium (5–20%) [8,16] are considerably different than those in Japan (E. faecium strains account for 40%) [4]. There are many studies on enterococcal bacteremia, the clinical outcomes, epidemiological features, and risk factors for nosocomial infection produced different results depending on the country, hospitalization ward, or patient characteristics. We aimed to investigate the clinico-epidemiological features and risk factors predisposing to the acquisition of E. faecium strains and mortality due to nosocomial enterococcal bacteremia
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