Vancomycin-resistant enterococci bacteremia: Risk factors for mortality and influence of antimicrobial therapy on clinical outcome

Sang Hoon Han, Bum Sik Chin, Han Sung Lee, Su Jin Jeong, Hee Kyoung Choi, Chang Oh Kim, Dongeun Yong, Jun Yong Choi, Young Goo Song, Kyungwon Lee, June Myung Kim

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Abstract

Objectives: This study evaluated the effects of antimicrobial treatment against vancomycin-resistant enterococci (VRE) and delayed administration of anti-VRE therapy on mortality, and determined independent risk factors for delayed all-cause mortality of VRE bacteremia patients. Methods: Over 10 years, 153 patients with clinically significant monomicrobial VRE bacteremia were identified among a total of 2834 patients in a VRE cohort. The main outcomes were immediate (7-day) and delayed (28-day, 60-day) all-cause mortality. Results: The 7-day (P < 0.001) and 28-day (P = 0.041) mortalities were lower in the group receiving anti-VRE therapy, but the 60-day mortality (P = 0.113) was unaffected. The mortalities of patients receiving anti-VRE therapy later than 72 h after the onset of bacteremia were no different from that of patients receiving treatment within 72 h. Both a higher APACHE II score (hazard ratio [HR], 1.10; P < 0.001 and HR, 1.12; P < 0.001, respectively) and the presence of septic shock at the onset of bacteremia (HR, 1.91; P = 0.047 and HR, 1.78; P = 0.034, respectively) were independent risk factors for 28-day and 60-day mortality. Conclusion: These findings suggest that in spite of antibiotic therapy against VRE, patients with VRE bacteremia eventually have a higher risk of death because of severe illness at the onset of bacteremia.

Original languageEnglish
Pages (from-to)182-190
Number of pages9
JournalJournal of Infection
Volume58
Issue number3
DOIs
Publication statusPublished - 2009 Mar 1

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Bacteremia
Mortality
Therapeutics
Vancomycin-Resistant Enterococci
APACHE
Septic Shock
Anti-Bacterial Agents

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Han, Sang Hoon ; Chin, Bum Sik ; Lee, Han Sung ; Jeong, Su Jin ; Choi, Hee Kyoung ; Kim, Chang Oh ; Yong, Dongeun ; Choi, Jun Yong ; Song, Young Goo ; Lee, Kyungwon ; Kim, June Myung. / Vancomycin-resistant enterococci bacteremia : Risk factors for mortality and influence of antimicrobial therapy on clinical outcome. In: Journal of Infection. 2009 ; Vol. 58, No. 3. pp. 182-190.
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abstract = "Objectives: This study evaluated the effects of antimicrobial treatment against vancomycin-resistant enterococci (VRE) and delayed administration of anti-VRE therapy on mortality, and determined independent risk factors for delayed all-cause mortality of VRE bacteremia patients. Methods: Over 10 years, 153 patients with clinically significant monomicrobial VRE bacteremia were identified among a total of 2834 patients in a VRE cohort. The main outcomes were immediate (7-day) and delayed (28-day, 60-day) all-cause mortality. Results: The 7-day (P < 0.001) and 28-day (P = 0.041) mortalities were lower in the group receiving anti-VRE therapy, but the 60-day mortality (P = 0.113) was unaffected. The mortalities of patients receiving anti-VRE therapy later than 72 h after the onset of bacteremia were no different from that of patients receiving treatment within 72 h. Both a higher APACHE II score (hazard ratio [HR], 1.10; P < 0.001 and HR, 1.12; P < 0.001, respectively) and the presence of septic shock at the onset of bacteremia (HR, 1.91; P = 0.047 and HR, 1.78; P = 0.034, respectively) were independent risk factors for 28-day and 60-day mortality. Conclusion: These findings suggest that in spite of antibiotic therapy against VRE, patients with VRE bacteremia eventually have a higher risk of death because of severe illness at the onset of bacteremia.",
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Vancomycin-resistant enterococci bacteremia : Risk factors for mortality and influence of antimicrobial therapy on clinical outcome. / Han, Sang Hoon; Chin, Bum Sik; Lee, Han Sung; Jeong, Su Jin; Choi, Hee Kyoung; Kim, Chang Oh; Yong, Dongeun; Choi, Jun Yong; Song, Young Goo; Lee, Kyungwon; Kim, June Myung.

In: Journal of Infection, Vol. 58, No. 3, 01.03.2009, p. 182-190.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Vancomycin-resistant enterococci bacteremia

T2 - Risk factors for mortality and influence of antimicrobial therapy on clinical outcome

AU - Han, Sang Hoon

AU - Chin, Bum Sik

AU - Lee, Han Sung

AU - Jeong, Su Jin

AU - Choi, Hee Kyoung

AU - Kim, Chang Oh

AU - Yong, Dongeun

AU - Choi, Jun Yong

AU - Song, Young Goo

AU - Lee, Kyungwon

AU - Kim, June Myung

PY - 2009/3/1

Y1 - 2009/3/1

N2 - Objectives: This study evaluated the effects of antimicrobial treatment against vancomycin-resistant enterococci (VRE) and delayed administration of anti-VRE therapy on mortality, and determined independent risk factors for delayed all-cause mortality of VRE bacteremia patients. Methods: Over 10 years, 153 patients with clinically significant monomicrobial VRE bacteremia were identified among a total of 2834 patients in a VRE cohort. The main outcomes were immediate (7-day) and delayed (28-day, 60-day) all-cause mortality. Results: The 7-day (P < 0.001) and 28-day (P = 0.041) mortalities were lower in the group receiving anti-VRE therapy, but the 60-day mortality (P = 0.113) was unaffected. The mortalities of patients receiving anti-VRE therapy later than 72 h after the onset of bacteremia were no different from that of patients receiving treatment within 72 h. Both a higher APACHE II score (hazard ratio [HR], 1.10; P < 0.001 and HR, 1.12; P < 0.001, respectively) and the presence of septic shock at the onset of bacteremia (HR, 1.91; P = 0.047 and HR, 1.78; P = 0.034, respectively) were independent risk factors for 28-day and 60-day mortality. Conclusion: These findings suggest that in spite of antibiotic therapy against VRE, patients with VRE bacteremia eventually have a higher risk of death because of severe illness at the onset of bacteremia.

AB - Objectives: This study evaluated the effects of antimicrobial treatment against vancomycin-resistant enterococci (VRE) and delayed administration of anti-VRE therapy on mortality, and determined independent risk factors for delayed all-cause mortality of VRE bacteremia patients. Methods: Over 10 years, 153 patients with clinically significant monomicrobial VRE bacteremia were identified among a total of 2834 patients in a VRE cohort. The main outcomes were immediate (7-day) and delayed (28-day, 60-day) all-cause mortality. Results: The 7-day (P < 0.001) and 28-day (P = 0.041) mortalities were lower in the group receiving anti-VRE therapy, but the 60-day mortality (P = 0.113) was unaffected. The mortalities of patients receiving anti-VRE therapy later than 72 h after the onset of bacteremia were no different from that of patients receiving treatment within 72 h. Both a higher APACHE II score (hazard ratio [HR], 1.10; P < 0.001 and HR, 1.12; P < 0.001, respectively) and the presence of septic shock at the onset of bacteremia (HR, 1.91; P = 0.047 and HR, 1.78; P = 0.034, respectively) were independent risk factors for 28-day and 60-day mortality. Conclusion: These findings suggest that in spite of antibiotic therapy against VRE, patients with VRE bacteremia eventually have a higher risk of death because of severe illness at the onset of bacteremia.

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