Risk factors and outcomes associated with persistent vancomycin resistant Enterococcal Bacteremia

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Critical Care Medicine

Background:

• Vancomycin-resistant enterococcus (VRE) bacteremia lasting ≥4 days is linked to increased mortality.
• Identifying patients at high risk for persistent VRE bacteremia is crucial for targeted interventions.
• Current literature lacks data on predictors of persistent VRE bacteremia.

Purpose of the Study:

• To identify risk factors associated with persistent VRE bacteremia.
• To analyze predictors of prolonged VRE bloodstream infections.
• To inform clinical strategies for managing VRE infections.

Main Methods:

• Retrospective, case-control study at a single center.
• Adult patients with VRE bloodstream infection (BSI) were analyzed.
• Logistic regression identified risk factors for persistent VRE BSI (≥4 days).

Main Results:

• 22% of patients (24/108) had persistent VRE bacteremia.
• Risk factors included severe neutropenia (OR 2.13), 4/4 positive index blood cultures (OR 11.29), and lack of source control (OR 11.88).
• No significant differences in mortality, recurrent, or breakthrough bacteremia were observed between groups.

Conclusions:

• Severe neutropenia, all positive index blood cultures, and inadequate source control predict persistent VRE bacteremia.
• These factors highlight patient subgroups requiring closer monitoring and aggressive management.
• Early identification of these risk factors can guide treatment adjustments for VRE infections.