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Risk Factors for Mortality Associated With Enterococcal Bloodstream Infections

Published online by Cambridge University Press:  02 January 2015

Leonardo Stroud ,
Jonathan Edwards ,
Lisa Danzig ,
David Culver  and
Robert Gaynes
Leonardo Stroud*
Affiliation:
National Nosocomial Infections Surveillance (NNIS) System, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan Edwards
Affiliation:
National Nosocomial Infections Surveillance (NNIS) System, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Lisa Danzig
Affiliation:
National Nosocomial Infections Surveillance (NNIS) System, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David Culver
Affiliation:
National Nosocomial Infections Surveillance (NNIS) System, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert Gaynes
Affiliation:
National Nosocomial Infections Surveillance (NNIS) System, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Mailstop E-55, Hospital Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333
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Abstract

Objective:

To determine risk factors for mortality in patients with a nosocomial enterococcal primary bloodstream infection (EPBI) and to assess whether vancomycin resistance placed a patient at increased risk of death.

Design/Setting:

A retrospective cohort study was conducted in four National Nosocomial Infection Surveillance System hospitals.

Results:

Of 145 patients identified with EPBIs, 74 (51%) died, and 26 (18%) had a vancomycin-resistant isolate. Upon comparing patients with EPBIs who survived to those who died, no associations were found between mortality and prior invasive device use, procedure history, type or number of prior nosocomial infections, length of hospitalization before infection, or receipt of vancomycin. Independent predictors of mortality were indices of severity of illness (APACHE II score and comorbidity weighted index), age, the use of third-generation cephalosporins or metronidazole during the week prior to infection, and female gender.

Conclusions:

Vancomycin resistance was not an independent predictor of death, and its role was difficult to establish, because cohort patients were among the most severely ill of all hospitalized patients. Enterococcal primary bloodstream infections appear to indicate severe, life-threatening disease processes. The pathogenicity of enterococci and the role of vancomycin resistance as a cause of mortality in patients with EPBIs need to be assessed further.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 9 , September 1996 , pp. 576 - 580
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996 

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References

1. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:596–598.Google Scholar
2. Emori, TG, Gaynes, RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428–442.Google Scholar
3. Korten, V. The nosocomial transmission of enterococci. Curr Opin Infect Dis 1993;6:498–505.Google Scholar
4. Graninger, W. Nosocomial bacteremia due to E faecalis without endocarditis. Clin Infect Dis 1992;15:49–57.Google Scholar
5. Zervos, MJ, Kauffman, CA, Therasse, PM, et al. Nosocomial infection by gentamicin-resistant Streptococcus faecalis: an epidemiologic study. Ann Intern Med 1989;110:515–520.Google Scholar
6. Handwerger, S, Raucher, B, Altarac, D. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.Google Scholar
7. Livornese, LL, Dias, S, Samel, C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.Google Scholar
8. Leclercq, R. Resistance of enterococci to aminoglycosides and glycopeptides. Clin Infect Dis 1992;15:495–501.Google Scholar
9. Patterson, J. High-level gentamicin resistance in Enterococcus: microbiology, genetic basis, and epidemiology. Rev Infect Dis 1990;12:644–652.Google Scholar
10. Johnson, AP, Uttley, AHC, Woodford, N, George, RC. Resistance to vancomycin and teicoplanin: an emerging problem. Clin Microbiol Rev 1990;3:280–291.Google Scholar
11. Kaye, D. Enterococci. Biologic and epidemiologic characteristics and in vitro susceptibility. Arch Intern Med 1982;142:2006–2009.Google Scholar
12. Horvitz, RA, von Graevenitz, A. A clinical study of the role of enterococci as sole agents of wound and tissue infection. Yale J Biol Med 1977;50:391–395.Google Scholar
13. Murray, BE. The life and times of the enterococcus. Clin Microbiol Rev 1990;3:46–65.Google Scholar
14. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
15. Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.Google Scholar
16. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987;40:373–383.Google Scholar
17. Horan, TC, White, JW, Jarvis, WR, et al. Nosocomial infection surveillance 1984. MMWR 1986;35:17S–29S.Google Scholar
18. Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infection Surveillance System (NNIS): description of surveillance methodology. Am J Infect Control 1991;19:19–35.Google Scholar
19. SAS Institute Inc. SAS/STAT User's Guide. Version 6, 4th ed, Vol II. Cary, NC: SAS Institute Inc; 1989.Google Scholar
20. Shlaes, DM, Levy, J, Wolinsky, E. Enterococcal bacteremia without endocarditis. Arch Intern Med 1981;141:578–581.Google Scholar
21. Dougherty, SH, Flohr, AB, Simmons, RL. ‘Breakthrough’ enterococcal septicemia in surgical patients: 19 cases and a review of the literature. Arch Surg 1983;118:232–238.Google Scholar
22. Craven, DE, Kunches, LM, Lichtenburg, PA, et al. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 1988;148:1161–1168.Google Scholar
23. Knaus, WA, Wagner, DP, Draper, EA. Relationships between acute physiologic derangement and risk of death. J Chron Dis 1985;38:295–300.Google Scholar
24. Wagner, DP, Knaus, WA, Draper, EA. Physiologic abnormalities and outcomes from acute disease: evidence for a predictable relationship. Arch Intern Med 1986;146:1389–1396.Google Scholar
25. Hoge, CW, Adams, J, Buchanan, B, Sears, SD. Enterococcal bacteremia: to treat or not to treat, a reappraisal. Rev Infect Dis 1991;13:600–605.Google Scholar
26. Dubois, RW, Book, RH, Rogers, WH. Adjusted hospital death rates: a potential screen for quality of medical care. Am J Public Health 1987;77:1162–1167.Google Scholar
27. Knaus, WA, Nash, DB. Predicting and evaluating patient outcomes. Ann Intern Med 1988;109:521–522.Google Scholar
28. Bryan, CS, Reynolds, KL, Brown, JJ. Mortality associated with enterococcal bacteremia. Surg Gynecol Obstet 1985;160:557–561.Google Scholar
29. Maki, DG, Agger, W. Enterococcal bacteremia: clinical features, the risk of endocarditis and management. Medicine 1988;67:248–269.Google Scholar
30. Gullberg, RM, Homann, SR. Enterococcal bacteremia: analysis of 75 episodes. Rev Infect Dis 1989;11:74–85.Google Scholar