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Outcomes of invasive infection due to vancomycin-resistant Enterococcus faecium during a recent outbreak

C Theilacker1, D Jonas, J Huebner

  • 1Center for Infectious Diseases and Travel Medicine, Dept. of Medicine, University Hospital, Freiburg, Germany. christian.theilacker@uniklinik-freiburg.de

Infection
|August 12, 2009
PubMed
Abstract

Insights

Invasive vancomycin-resistant Enterococcus faecium (VREF) infections remain deadly, even with newer antibiotics. This study found high mortality in VREF patients with severe comorbidities, highlighting the need for effective treatment strategies.

Area of Science:

  • Infectious Diseases
  • Antimicrobial Resistance
  • Clinical Microbiology

Background:

  • Vancomycin-resistant Enterococcus faecium (VREF) infections are associated with high mortality.
  • Previous studies on VREF outcomes were limited by older antimicrobial options.
  • Emergence of newer VREF-active antimicrobials prompted re-evaluation of VREF infection outcomes.

Purpose of the Study:

  • To evaluate patient characteristics and outcomes of invasive VREF infections during an outbreak.
  • To assess the impact of newer VREF-active antimicrobials on mortality.
  • To identify risk factors associated with poor outcomes in VREF infections.

Main Methods:

  • Retrospective chart review of 25 invasive VREF infection cases during a tertiary care hospital outbreak.
  • Descriptive analysis of patient demographics, underlying diseases, and comorbidities.
  • Evaluation of antimicrobial treatment, including newer agents like linezolid and quinupristin-dalfopristin.

Main Results:

  • VREF infections predominantly occurred in patients with severe underlying diseases (e.g., leukemia) and rapidly fatal comorbidities.
  • Most patients received high-dose chemotherapy and were neutropenic at VREF infection onset.
  • Overall 30-day survival was 48%, with four deaths directly attributed to VREF infection; linezolid resistance was noted in four cases.

Conclusions:

  • Invasive VREF infections during the outbreak were concentrated in severely comorbid patients.
  • Mortality associated with VREF infection remains high, irrespective of treatment with newer VREF-active antibiotics.
  • Effective management strategies for VREF in critically ill patients require further investigation.

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