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Outcomes associated with vancomycin-resistant enterococci: a meta-analysis.

Cassandra D Salgado¹, Barry M Farr

¹Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA.

Infection Control and Hospital Epidemiology

|September 27, 2003

Summary

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Vancomycin-resistant Enterococcus bacteremia (VREB) is associated with significantly higher mortality and recurrence rates compared to vancomycin-susceptible Enterococcus bacteremia (VSEB). Available data suggest VREB also leads to increased healthcare costs and longer hospital stays.

Area of Science:

Infectious Diseases
Clinical Microbiology
Healthcare Epidemiology

Background:

Vancomycin-resistant Enterococcus bacteremia (VREB) presents a significant clinical challenge.
Previous studies have been limited in determining if VREB outcomes are worse than vancomycin-susceptible Enterococcus bacteremia (VSEB) due to patient severity of illness.
Clarifying the independent impact of VREB on patient outcomes is crucial for effective treatment strategies.

Purpose of the Study:

To compare the morbidity, mortality, and cost outcomes between VREB and VSEB.
To assess the attributable mortality and recurrence rates associated with VREB.
To evaluate the impact of VREB on length of stay and healthcare costs.

Main Methods:

A systematic review and meta-analysis of studies comparing VREB and VSEB was conducted.

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Data were pooled from Medline and meeting abstracts published between January 1986 and April 2002.

Heterogeneity was assessed using chi-square tests, and multivariate analyses controlled for confounding factors.

Main Results:

VREB case fatality was significantly higher than VSEB (48.9% vs. 19%), with attributable mortality estimated at 30%.
When bacteremia was the direct cause of death, VREB case fatality remained significantly higher (39.1% vs. 21.8%).
VREB was associated with significantly higher recurrence rates (16.9% vs. 3.7%) and increased length of stay and costs.

Conclusions:

Despite limitations in some studies, available data indicate VREB is associated with increased mortality, recurrence, and excess costs compared to VSEB.
Multivariate analyses, adjusting for illness severity, support VREB as an independent predictor of adverse outcomes.
Further research with adequate sample sizes and robust statistical adjustments is warranted to fully elucidate VREB's impact.