Epidemiology and Infection

Antibiotics and antibiotic resistance: veterinary and human

Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents

J. A. McKINNELLa1a2 c1, M. PATELa3a4, R. M. SHIRLEYa3, D. F. KUNZa5, S. A. MOSERa6 and J. W. BADDLEYa3a4

a1 Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Division of Infectious Diseases, Torrance, CA, USA

a2 Torrance Memorial Medical Center, Torrance, CA, USA

a3 University of Alabama at Birmingham, Division of Infectious Disease, Birmingham, AL, USA

a4 Birmingham Veterans Administration Medical Center, Birmingham, AL, USA

a5 University of Alabama at Birmingham, Department of Pharmacy, Birmingham, AL, USA

a6 University of Alabama at Birmingham, Department of Pathology, Birmingham, AL, USA

SUMMARY

Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSI) are a growing problem with few clinical trials to guide therapy. We conducted a retrospective study of management and predictors of mortality for VRE-BSI at a tertiary-care centre from January 2005 to August 2008. Univariate and multivariable analyses examined the relationship of patient characteristics and antibiotic therapy with 30-day all-cause mortality. Rates of VRE-BSI increased from 0·06 to 0·17 infections/1000 patient-days (P=0·03). For 235 patients, 30-day mortality was 34·9%. Patients were primarily treated with linezolid (44·2%) or daptomycin (36·5%). Factors associated with mortality were haemodialysis [odds ratio (OR) 3·2, 95% confidence interval (CI) 1·6–6·3, P=0·007], mechanical ventilation (OR 3·7, 95% CI 1·3–10·4, P=0·01), and malnutrition (OR 2·0, 95% CI 1·0–4·0, P=0·046). Use of linezolid, but not daptomycin (P=0·052) showed a trend towards an association with survival. In conclusion, VRE-BSI is a growing problem, associated with significant 30-day mortality. Multiple factors were associated with poor outcomes at our hospital.

(Accepted October 01 2010)

(Online publication November 15 2010)

Correspondence:

c1 Author for correspondence: J. A. McKinnell, M.D., Los Angeles Biomedical Research Institute, Division of Infectious Diseases, 1124 West Carson Street, Torrance, CA 90502, USA. (Email: Dr.McKinnell@yahoo.com)

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