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Abstract Objective Previous meta-analyses have demonstrated that vancomycin-resistant Enterococcus (VRE) bacteremia is associated with increased mortality compared to vancomycin-sensitive Enterococcus (VSE) bacteremia. However, these studies relied on unadjusted data, which could potentially lead to an overestimation of the mortality risk. Therefore, we performed this systematic review with meta-analysis to investigate the impact of vancomycin resistance on adverse outcomes in enterococci blood stream infection (BSI) based on studies that were conducted after 2000 (when effective VRE therapies became available) and adjusted for age, underlying medical conditions, and time to appropriate antibiotics. Results Out of 2559 articles reviewed, four eligible articles were included in this study. Overall, vancomycin resistance was not significantly associated with increased mortality in Enterococci BSI (pooled adjusted hazard ratio for 30-day mortality, 0.927 (95% CI, 0.51 to 1.686), P = 0.8, I2% = 13.7, number of studies = 3). The remaining study reported that vancomycin resistance was not associated with in-hospital mortality (adjusted odds ratio 1.21 (95% CI, 0.53 to 2.79), P = 0.653). These findings suggest that vancomycin resistance is not a significant independent predictor of mortality in Enterococci BSI when adjusted for age, underlying medical conditions, and time to appropriate antibiotics.
Azzam et al. (Tue,) studied this question.