Is there an association between colonisation of vancomycin resistant Enterococci, methicillin resistant Staphylococcus Aureus, or Clostridiodes Difficile and mortality in sepsis?

Abstract

Summary: Background: To determine if colonisation with drug resistant organisms is associated with worse outcomes in patients who subsequently develop sepsis. Methods: Retrospective study of patients with sepsis employing logistic regression and linear regression to determine the independent association of colonisation with adverse outcomes. Results: Mortality was higher in patients colonized with VRE [501 of 1937 (26%) v. 1052 of 5624 (19%) non-VRE colonised patients, difference 7% (95% confidence interval (5,9%), p<0.001] and MRSA [168 of 708 (24%) v 1342 of 6804 (20%) non-MRSA colonised patients, difference 4% (1,7%), p = 0.014]. CDiff colonisation was not associated with increased mortality [153 of 757 (21%) v 762 of 7432 (18%), difference 3% (0,6%), p=0.052]. After multivariable logistic regression, VRE colonisation remained associated with increased hospital mortality [odds ratio = 1.273, 95% confidence interval (1.099, 1.475), p = 0.001]. VRE colonisation was also associated with subsequent receipt of mechanical ventilation [odds ratio = 1.179, 95% confidence interval (1.043, 1.334), p = 0.009] and with receipt of renal replacement therapy (RRT) [OR = 1.36 (1.11, 1.66), p = 0.003]. Conclusions: We found that VRE colonisation, but not MRSA or C. diff colonisation, was associated with increased hospital mortality in septic patients.

Keywords

• Infection control
• Vancomycin-resistant enterococci
• Methicillin-resistant Staphylococcus Aureus
• Clostridiodes difficile
• Sepsis