Bloodstream Infections With Vancomycin-Resistant Enterococci

Marisa A. Montecalvo, MD; David K. Shay, MD; Pankaj Patel, MD; Leoncio Tacsa, MD; Susan A. Maloney, MD; William R. Jarvis, MD; Gary P. Wormser, MD
Arch Intern Med. 1996;156(13):1458-1462. doi:10.1001/archinte.1996.00440120120013.
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Objectives:  To describe the population in whom bloodstream infections with vancomycin-resistant enterococci occur and the clinical and microbiologic features of infection.

Methods:  From June 1, 1991, to January 31, 1994, 73 patients with bloodstream infections with vancomycin-resistant enterococci were identified by retrospective review of hospital charts and microbiology records.

Results:  Fifty-two (73%) of 71 patients with evaluable data were hospitalized in an intensive care unit, the adult oncology unit, or the acquired immunodeficiency syndrome unit. Before the development of the bloodstream infection with vancomycin-resistant enterococci, patients were hospitalized and received antibiotics for a median of 26 and 25.5 days, respectively. A hematologic malignancy, respiratory failure, or renal failure requiring dialysis was present in 59 patients (83%). Acute Physiology and Chronic Health Evaluation II scores of the patients ranged from 6 to 35 (median, 17). Forty-five (63%) of the patients died. Compared with 37 patients who had only a single positive blood culture, the 34 patients with 2 or more blood cultures positive for vancomycin-resistant enterococci more often were neutropenic or had acquired immunodeficiency syndrome (74% vs 35%; P=.002).

Conclusions:  Bloodstream infections with vancomycin-resistant enterococci predominantly affect severely ill patients who have received extensive antibiotic treatment during a prolonged hospitalization. Immunocompromised patients are more likely to have a persistent bloodstream infection with vancomycin-resistant enterococci.Arch Intern Med. 1996;156:1458-1462


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