Document Detail


Enterococcus faecium bacteremia: does vancomycin resistance make a difference?
MedLine Citation:
PMID:  9508230     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Enterococcus faecium has received increased attention, primarily due to the emergence of vancomycin resistance. The purpose of this investigation was to study the epidemiological characteristics of vancomycin-resistant E faecium (VRE) bacteremia and to determine the clinical impact of vancomycin resistance on the outcome of patients with this infection. METHODS: We retrospectively analyzed the clinical features and outcome of 53 patients with E faecium bacteremia. RESULTS: From January 1992 until December 1995, there were 32 episodes of bacteremia caused by vancomycin-susceptible E faecium (VSE) and 21 caused by VRE. An intra-abdominal site was the most common source of bacteremia in both groups. All of the VRE and 78% of VSE bacteremia cases were nosocomially acquired. Previous administration of vancomycin was associated with VRE bacteremia (P<.001), as were indwelling bladder catheters (P=.01). Fifty-nine percent of the patients with VSE bacteremia survived vs 24% with VRE (P=.009), despite similar severity-of-illness scores. In 62% of the patients with VRE sepsis, death was related to the bacteremia (P=.01). Patients infected with VRE had longer hospitalizations than those with VSE (34.8 vs 16.7 days, respectively) (P=.004), were more likely to be on the medical service (P=.03), and on the average, had hospitalization costs of more than $27,000 per episode than did patients with VSE bloodstream infection ($83,897 vs $56,707, respectively) (P=.04). CONCLUSIONS: Vancomycin-resistant E faecium bacteremia is a complication of prolonged hospitalization in debilitated patients. Vancomycin resistance has a negative impact on survival in patients with E faecium bacteremia and leads to higher health care costs.
Authors:
V Stosor; L R Peterson; M Postelnick; G A Noskin
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of internal medicine     Volume:  158     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  1998 Mar 
Date Detail:
Created Date:  1998-03-24     Completed Date:  1998-03-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  522-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Northwestern University Medical School, Chicago, Ill 60611, USA.
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / pharmacology*
Bacteremia / drug therapy*,  etiology,  microbiology*
Drug Resistance, Microbial
Enterococcus faecium*
Female
Gram-Positive Bacterial Infections / drug therapy*,  etiology,  microbiology*
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Vancomycin / pharmacology*
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 1404-90-6/Vancomycin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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