Vergis et al identified risk factors for vancomycin resistance and short-term mortality in patients with enterococcoal bacteremia. These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Pittsburgh, VA Pittsburgh Healthcare System, Rush-Presbyterian-St. Luke’s Medical Center, Wayne State University, New England Medical Center and William Beaumont Hospital.
Patient selection: enterococcal bacteremia
Isolates: primarily Enterococcus faecalis (60%) and E. faecium (37%)
Outcomes:
(1) vancomycin resistance
(2) 14-day mortality (short-term mortality)
Risk factors for vancomycin resistance:
(1) history of vancomycin therapy (OR 5.8)
(2) history of corticosteroid therapy (OR 2.4)
(3) APACHE II score at bacteremia onset (OR 1.06 per unit)
Risk factors for 14-day mortality:
(1) hematologic malignancy (OR 3.8)
(2) vancomycin resistance (OR 2.1)
(3) APACHE II score at bacteremia onset (OR 1.10 per unit)
(4) effective antimicrobial therapy within 48 hours if monomicrobial enterococcal bacteremia (OR 0.21)
