What question did this study set out to answer?

The aim was to evaluate factors influencing 14-day mortality in vancomycin-resistant Enterococcus faecium bloodstream infections.

May 30, 2026Open Access

Clinical Outcomes and Molecular Epidemiology of Vancomycin-Resistant Enterococcus faecium Bloodstream Infection: The Importance of Appropriate Therapy and ST17 Predominance

Key Points

The aim was to evaluate factors influencing 14-day mortality in vancomycin-resistant Enterococcus faecium bloodstream infections.
Randomly selected 150 VREfm blood isolates from a tertiary medical center in Northern Taiwan (2021–2023).
Resistance genes detected by PCR; multilocus sequence typing (MLST) and biofilm assays performed.
Primary outcome was analyzed among patients surviving at least three days post-BSI onset to address immortal-time bias.
In the analysis of 137 patients, no anti-VRE therapy was independently associated with increased mortality (aOR 10.44, 95% CI 1.07-101.86; P = 0.04).
Mortality was also linked to higher Pitt bacteraemia score (aOR 1.27; P = 0.003) and lower platelet count (aOR 0.92; P = 0.003).
Daptomycin and linezolid were associated with reduced mortality compared to no anti-VRE therapy (aOR 0.11, P = 0.05 and aOR 0.05, P = 0.04, respectively).

Abstract

ABSTRACT Background Vancomycin-resistant Enterococcus faecium (VREfm) bloodstream infection (BSI) remains associated with substantial mortality, and timely active therapy may be critical. We evaluated factors associated with 14-day mortality, focusing on anti-VRE therapy, and described contemporaneous molecular epidemiology and biofilm capacity. Methods We randomly selected 150 VREfm blood isolates (50/year) from a tertiary medical center in Northern Taiwan, 2021–2023. Resistance genes were detected by PCR; multilocus sequence typing (MLST) and biofilm assays were performed. The primary outcome was 14-day all-cause mortality, analysed primarily among patients who survived at least three days from BSI onset to mitigate immortal-time bias. Results ST17 predominated (58%), followed by ST78 (20%); all isolates carried vanA. Antimicrobial susceptibility did not differ between ST17 and non-ST17 isolates. ST17 demonstrated greater biofilm formation (median OD 550 0.79 vs 0.44; P <0.001), but neither ST17 status nor biofilm production was associated with 14-day mortality. In the primary outcome analysis (n=137), multivariable analysis showed mortality was independently associated with no anti-VRE therapy (adjusted odds ratio aOR 10.44, 95% confidence interval CI 1.07-101.86; P =0.04), higher Pitt bacteraemia score (aOR 1.27; P =0.003), autoimmune disease (aOR 21.90; P=0.02), and lower platelet count (aOR 0.92; P =0.003). Compared with no anti-VRE therapy, daptomycin (aOR 0.11, 95% CI 0.01-1.03; P =0.05) and linezolid (aOR 0.05, 95% CI 0.003-0.84; P =0.04) were associated with reduced mortality. Findings were consistent in the 150-patient sensitivity analysis. Conclusions Mortality in VREfm BSI was primarily associated with host factors, illness severity, and receipt of anti-VRE therapy. ST17 predominated and showed enhanced biofilm formation, but was not independently associated with mortality.

Read Full Paperexternally

Bookmark

View Full Paper

Cite This Study

Hsu et al. (Fri,) studied this question.

synapsesocial.com/papers/6a1a7e6a0307b7850943116a https://doi.org/https://doi.org/10.1016/j.jiph.2026.103274

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

Bookmark

View Full Paper