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Risk factors for vancomycin resistance in patients with Enterococcus faecium bloodstream infections: an analysis of
Laura Wagner1,2, Milena Wurst1, Johanna Erber1,2
1Department of Internal Medicine II, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich, Munich, Germany.
Abstract:
Enterococcus faecium is difficult to treat owing to its intrinsic and acquired resistance to antibiotics, particularly vancomycin. Vancomycin-resistant Enterococcus faecium is an important cause of bloodstream infections in healthcare settings with limited treatment options. This study aimed to analyze the risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection. This retrospective analysis of data from the Munich Multicentric Enterococci Cohort analyzed 200 episodes of nonrecurrent vancomycin-susceptible Enterococcus faecium bloodstream infection and 196 episodes of nonrecurrent vancomycin-resistant Enterococcus faecium bloodstream infection from six hospitals in Munich, Germany, between 2010 and 2019. Logistic regression was used to identify risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection. In the unadjusted analysis, the risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection included the length of hospital stay, previous treatment with vancomycin or linezolid, and solid organ transplantation. In the multivariable analysis, prior treatment with vancomycin and solid organ transplantation were independent risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection. Vancomycin resistance was not significantly associated with the severity of underlying diseases. This study identified prior vancomycin treatment and solid organ transplantation as key independent risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection.
Importance:
Vancomycin-resistant Enterococcus faecium is a growing threat in healthcare settings, challenging the management of enterococcal infections. This study identified prior treatment with vancomycin and solid organ transplantation as risk factors for vancomycin-resistant Enterococcus faecium bloodstream infections. Based on the analysis of five disease severity scores for acute and chronic illness, the severity of underlying diseases could not be demonstrated to be a risk factor for the occurrence of vancomycin resistance in Enterococcus faecium bloodstream infections.
Insights
Prior vancomycin treatment and solid organ transplantation are key risk factors for vancomycin-resistant Enterococcus faecium bloodstream infections. These infections pose a significant challenge in healthcare settings due to limited treatment options.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Vancomycin-resistant Enterococcus faecium (VREfm) is a significant cause of healthcare-associated bloodstream infections.
- VREfm infections are challenging to treat due to intrinsic and acquired antibiotic resistance, particularly to vancomycin.
- Limited therapeutic options exist for VREfm infections, highlighting the need to identify risk factors.
Purpose of the Study:
- To identify independent risk factors for vancomycin-resistant Enterococcus faecium bloodstream infections.
- To analyze the association between underlying disease severity and VREfm bloodstream infections.
Main Methods:
- Retrospective cohort analysis of 396 episodes of Enterococcus faecium bloodstream infections (200 VRE-susceptible, 196 VRE-resistant).
- Data collected from six hospitals in Munich, Germany, between 2010 and 2019.
- Logistic regression analysis to determine independent risk factors.
Main Results:
- Prior vancomycin treatment was identified as an independent risk factor for VREfm bloodstream infection.
- Solid organ transplantation was identified as another independent risk factor for VREfm bloodstream infection.
- No significant association was found between the severity of underlying diseases and VREfm bloodstream infection.
Conclusions:
- Prior vancomycin exposure and solid organ transplantation are critical independent risk factors for VREfm bloodstream infections.
- Disease severity does not appear to be a significant risk factor for VREfm bloodstream infections.
- These findings can inform infection control strategies and patient management in healthcare settings.
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