Enterococcus faecium Bacteremia

BACKGROUND: Enterococcus faecium has received increased attention, primarily due to the emergence of vancomycin resistance. The purpose of this investigation was to study the epidemiological characteristics of vancomycin-resistant E faecium (VRE) bacteremia and to determine the clinical impact of vancomycin resistance on the outcome of patients with this infection. METHODS: We retrospectively analyzed the clinical features and outcome of 53 patients with E faecium bacteremia. RESULTS: From January 1992 until December 1995, there were 32 episodes of bacteremia caused by vancomycin-susceptible E faecium (VSE) and 21 caused by VRE. An intra-abdominal site was the most common source of bacteremia in both groups. All of the VRE and 78% of VSE bacteremia cases were nosocomially acquired. Previous administration of vancomycin was associated with VRE bacteremia (P<. 001), as were indwelling bladder catheters (P=. 01). Fifty-nine percent of the patients with VSE bacteremia survived vs 24% with VRE (P=. 009), despite similar severity-of-illness scores. In 62% of the patients with VRE sepsis, death was related to the bacteremia (P=. 01). Patients infected with VRE had longer hospitalizations than those with VSE (34. 8 vs 16. 7 days, respectively) (P=. 004), were more likely to be on the medical service (P=. 03), and on the average, had hospitalization costs of more than 27, 000 per episode than did patients with VSE bloodstream infection (83, 897 vs 56, 707, respectively) (P=. 04). CONCLUSIONS: Vancomycin-resistant E faecium bacteremia is a complication of prolonged hospitalization in debilitated patients. Vancomycin resistance has a negative impact on survival in patients with E faecium bacteremia and leads to higher health care costs.