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Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream
Carlos A DiazGranados1, Shanta M Zimmer, Mitchel Klein
1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. cadiazg@fucsalud.edu.co
Background:
Whether vancomycin resistance is independently associated with mortality among patients with enterococcal bloodstream infection (BSI) is controversial. To address this issue, we performed a systematic literature review with meta-analysis.
Methods:
Data sources were studies identified using the MEDLINE database (for articles from 1988 through March 2003), the Cochrane Library (for articles published up to March 2003), and bibliographies of identified articles. Inclusion criteria were that the study assessed mortality after enterococcal BSI, compared mortality after vancomycin-resistant enterococci (VRE) BSI with that after vancomycin-susceptible enterococci (VSE) BSI, and adjusted for severity of illness. Study exclusion criteria were as follows: no report of the adjusted measure of effect (adjusted odds ratio [OR], adjusted hazard ratio, or adjusted relative risk) of vancomycin resistance on mortality available and/or its adjusted 95% confidence interval (95% CI). Data in the tables, figures, or text were independently extracted by 2 of the authors. Individual weights were calculated using the 95% CI of the adjusted measures of effect performing both fixed-effect and random-effects models.
Results:
Nine studies were eligible (11 studies met the inclusion criteria, and 2 were excluded), with a total of 1614 enterococcal BSI episodes (683 VRE episodes and 931 VSE episodes). Patients with bacteremia caused by VRE were more likely to die than were those with VSE bacteremia (summary OR, 2.52; 95% CI, 1.9-3.4).
Conclusions:
Vancomycin resistance is independently associated with increased mortality among patients with enterococcal bloodstream infection.
Insights
Vancomycin resistance in enterococcal bloodstream infections (BSI) is linked to higher mortality. This meta-analysis confirms vancomycin-resistant enterococci (VRE) BSI significantly increases the risk of death compared to vancomycin-susceptible enterococci (VSE) BSI.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Enterococcal bloodstream infections (BSI) present a significant clinical challenge.
- The impact of vancomycin resistance on mortality in enterococcal BSI remains a subject of debate.
Purpose of the Study:
- To systematically review and meta-analyze existing literature.
- To determine if vancomycin resistance is an independent predictor of mortality in patients with enterococcal BSI.
Main Methods:
- A comprehensive literature search was conducted using MEDLINE and the Cochrane Library.
- Inclusion criteria focused on studies reporting adjusted measures of effect for mortality in vancomycin-resistant enterococci (VRE) versus vancomycin-susceptible enterococci (VSE) BSI.
- Data extraction and analysis employed fixed-effect and random-effects models.
Main Results:
- Nine eligible studies, encompassing 1614 enterococcal BSI episodes (683 VRE, 931 VSE), were included.
- Patients with VRE bacteremia demonstrated a significantly higher likelihood of mortality compared to those with VSE bacteremia.
- The summary odds ratio for mortality associated with VRE was 2.52 (95% CI, 1.9-3.4).
Conclusions:
- Vancomycin resistance is independently associated with increased mortality in enterococcal bloodstream infections.
- These findings underscore the critical importance of managing VRE infections.
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