Risk factors and outcomes associated with vancomycin-resistant Enterococcus faecium and ampicillin-resistant Enterococcus faecalis bacteraemia: A 10-year study in a tertiary-care centre in Mexico City

Abstract

Objectives: We sought to identify risk factors associated with vancomycin-resistant Enterococcus faecium (VRE) and ampicillin-resistant Enterococcus faecalis (ARE) bacteraemia, predictors of 30-day mortality, and 90-day recurrence-free survival according to resistance. Methods: We evaluated clinical records of patients with E. faecalis and E. faecium bacteraemia (2007–2017). We performed bivariate and multivariate logistic regression analyses to identify factors associated with VRE and ARE bacteraemia and predictors of 30-day mortality. A Kaplan–Meier estimate of 90-day recurrence-free survival was done. Results: We identified 192 and 147 E. faecium and E. faecalis bacteraemia episodes, respectively, of which 55.7% of E. faecium were VRE (94% vanA) and 12.2% of E. faecalis were ARE. Factors related to VRE bacteraemia were previous hospitalisation (aOR, 80.18, 95% CI 1.81–634), history of central venous catheter (aOR, 11.15, 95% CI 2.48–50.2) and endotracheal cannula use (aOR, 17.91, 95% CI 1.22–262.82). There was higher attributable mortality to VRE (28%, 95% CI 14–68%; P < 0.001) and ARE (10%, 95% CI 0.1–36%; P = 0.58) compared with their susceptible counterparts. APACHE II (aOR, 1.45, 95% CI 1.26–1.66) and history of chemotherapy (aOR, 3.52, 95% CI 1.09–11.39) were predictors of E. faecium bacteraemia 30-day mortality. We could not recognise any factor related to ARE bacteraemia or E. faecalis 30-day mortality. Conclusion: History of hospitalisation and invasive device use were related to VRE bacteraemia. APACHE II and history of chemotherapy were predictors of mortality. We could not identify factors related to ARE or predictors of mortality.

Keywords

• Bacteraemia
• β-Lactam resistance
• Enterococcus
• Vancomycin resistance