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Attributable mortality of vancomycin resistance in ampicillin-resistant Enterococcus faecium bacteremia in Denmark

Wouter C Rottier1, Mette Pinholt2,3, Akke K van der Bij4

  • 1Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.

Infection Control and Hospital Epidemiology
|June 7, 2022
PubMed
Abstract

Insights

Vancomycin-resistant Enterococcus faecium (VRE) bacteremia is linked to increased mortality compared to ampicillin-resistant Enterococcus faecium (ARE) bacteremia. This higher mortality risk was not explained by delayed antibiotic treatment.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Epidemiology

Background:

  • Nosocomial Enterococcus faecium bacteremia is a significant healthcare concern.
  • The emergence of vancomycin-resistant Enterococcus faecium (VRE) poses a therapeutic challenge.
  • Understanding the impact of VRE on patient mortality is crucial for guiding clinical practice.

Purpose of the Study:

  • To determine if vancomycin-resistant Enterococcus faecium (VRE) bacteremia increases mortality compared to ampicillin-resistant Enterococcus faecium (ARE) bacteremia.
  • To investigate whether delayed antibiotic therapy mediates any increased mortality associated with VRE.
  • To analyze the impact of VRE on 30-day mortality in patients with Enterococcus faecium bacteremia.

Main Methods:

  • Retrospective, matched-cohort study design.
  • Inclusion of patients from 20 Dutch and Danish hospitals (2009-2014).
  • Matching VRE bacteremia cases with ARE bacteremia controls based on hospital, ward, prior hospital stay, and age.
  • Cox regression analysis to estimate the risk ratio for 30-day mortality.

Main Results:

  • The 30-day mortality rates for ARE bacteremia were 27% (Netherlands) and 38% (Denmark).
  • The 30-day mortality rates for VRE bacteremia were 33% (Netherlands) and 48% (Denmark).
  • VRE bacteremia was associated with a 1.54-fold increased risk of 30-day mortality (adjusted RR, 1.06-2.25).
  • Appropriate antibiotic therapy was initiated later for VRE than ARE, but this did not mediate the increased mortality.

Conclusions:

  • Vancomycin-resistant Enterococcus faecium (VRE) bacteremia is associated with higher 30-day mortality compared to ampicillin-resistant Enterococcus faecium (ARE) bacteremia.
  • The increased mortality risk associated with VRE may be due to increased intrinsic virulence or unmeasured confounding factors.
  • Delayed antibiotic therapy does not appear to mediate the increased mortality observed in VRE infections.

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