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Vancomycin-resistant enterococcal bacteremia: natural history and attributable mortality
M B Edmond1, J F Ober, J D Dawson
1Division of Quality Health Care, Medical College of Virginia Commonwealth University, Richmond 23298-0509, USA. MEDMOND@Gems.VCU.EDU
Summary
Vancomycin-resistant Enterococcus (VRE) bacteremia significantly increases the risk of severe sepsis and septic shock. This infection nearly doubles the risk of death, with attributable mortality approaching 40%.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Vancomycin-resistant Enterococcus (VRE) bacteremia is a serious healthcare-associated infection.
- Previous estimates of VRE bacteremia mortality (17%-100%) may be confounded by comorbid conditions.
Purpose of the Study:
- To determine the mortality specifically attributable to VRE bacteremia.
- To assess the association between VRE bacteremia and severe sepsis or septic shock.
Main Methods:
- A historical cohort study design was employed.
- Twenty-seven VRE bacteremia cases were matched 1:1 with controls without VRE bacteremia.
- Matching criteria included time of hospitalization, exposure duration, underlying disease, age, gender, and surgical procedure.
Main Results:
- VRE bacteremia was associated with high rates of severe sepsis (44%) and septic shock (37%).
- Mortality was 67% in VRE bacteremia cases versus 30% in matched controls (P=0.1).
- The attributable mortality was 37% (95% CI, 10%-64%), with a risk ratio for death of 2.3 (95% CI, 1.2-4.1).
Conclusions:
- VRE bacteremia is a significant independent risk factor for mortality.
- Patients with VRE bacteremia face a substantially increased risk of death compared to similar patients without this infection.
- Effective infection control and treatment strategies are crucial for managing VRE bacteremia.