Abstract
BACKGROUND Prior data suggest that vancomycin-resistant Enterococcus (VRE) bacteremia is associated with worse outcomes than vancomycin-sensitive Enterococcus (VSE) bacteremia. However, many studies evaluating such outcomes were conducted prior to the availability of effective VRE therapies. OBJECTIVE To systematically review VRE and VSE bacteremia outcomes among hospital patients in the era of effective VRE therapy. METHODS Electronic databases and grey literature published between January 1997 and December 2014 were searched to identify all primary research studies comparing outcomes of VRE and VSE bacteremias among hospital patients, following the availability of effective VRE therapies. The primary outcome was all-cause, in-hospital mortality, while total hospital length of stay (LOS) was a secondary outcome. All meta-analyses were conducted in Review Manager 5.3 using random-effects, inverse variance modeling. RESULTS Among all the studies reviewed, 12 cohort studies and 1 case control study met inclusion criteria. Similar study designs were combined in meta-analyses for mortality and LOS. VRE bacteremia was associated with increased mortality compared with VSE bacteremia among cohort studies (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.38-2.35; I2=0%; n=11); the case-control study estimate was similar, but not significant (OR, 1.93; 95% CI, 0.97-3.82). LOS was greater for VRE bacteremia patients than for VSE bacteremia patients (mean difference, 5.01 days; 95% CI, 0.58-9.44]; I2=0%; n=5). CONCLUSIONS Despite the availability of effective VRE therapy, VRE bacteremia remains associated with an increased risk of in-hospital mortality and LOS when compared to VSE bacteremia. Infect. Control Hosp. Epidemiol. 2015;37(1):26-35.
Highlights
vancomycin-resistant enterococci (VRE) bacteremia was associated with increased mortality compared with vancomycin-sensitive enterococci (VSE) bacteremia among cohort studies; the case-control study estimate was similar, but not significant (OR, 1.93; 95% confidence intervals (CI), 0.97–3.82)
Despite the availability of effective VRE therapy, VRE bacteremia remains associated with an increased risk of in-hospital mortality and length of stay (LOS) when compared to VSE bacteremia
Studies analyzing data collected between January 1997 and January 2000 were excluded if the antibiotics used for the treatment of VRE bacteremia patients were not reported or could not be obtained by contacting study authors
Summary
The Public Health Ontario (PHO) Library Services department assisted with the development and implementation of search strategies for electronic databases, as well as with the retrieval of full-text articles. Embase, CINAHL, ProQuest dissertations and theses, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from January 1997 to December 2014. A sample search strategy is provided in Supplemental Table 1. Websites of infection control authorities and proceedings from infection control conferences held within the most recent 5 years (ie, January 1, 2010, to January 1, 2015) were searched as outlined in Supplemental Table 2. Conference proceedings prior to 2010 were not considered because we assumed that valuable data contained within such abstracts had become available in peer-reviewed literature. The reference lists of all relevant publications were hand searched to identify additional citations
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