Clinical characteristics and outcomes of patients with vancomycin-susceptible Enterococcus faecalis and Enterococcus faecium bacteraemia in cancer patients

• Published in: European journal of clinical microbiology & infectious diseases 2011, Vol.30 (1), p.103-108
• Main Authors: Conde-Estévez, D, Grau, S, Albanell, J, Terradas, R, Salvadó, M, Knobel, H
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - pharmacology; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteremia - microbiology; Bacteremia - pathology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Brief Report; Cancer therapies; Enterococcus faecalis; Enterococcus faecalis - drug effects; Enterococcus faecalis - isolation & purification; Enterococcus faecium; Enterococcus faecium - drug effects; Enterococcus faecium - isolation & purification; Epidemiology; Female; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Gram-Positive Bacterial Infections - pathology; Hospitals; Hospitals, University; Human bacterial diseases; Humans; Infectious diseases; Intensive care; Internal Medicine; Male; Medical Microbiology; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Neoplasms - complications; Nosocomial infections; Pathogens; Patients; Penicillin; Pharmacology. Drug treatments; Pharmacy; Physiology; Regression analysis; Retrospective Studies; Risk Factors; Severity of Illness Index; Spain - epidemiology; Treatment Outcome
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-010-1029-5

The purpose of this investigation was to compare the risk factors, clinical features and outcomes in cancer patients with bacteraemia caused by vancomycin-susceptible Enterococcus faecalis and E. faecium. A retrospective, observational 7-year study was carried out in a 450-bed, acute-care university-affiliated hospital. We performed univariate comparisons between the two groups and then multivariate analysis to identify patient risk factors for E. faecium isolation. Seventy-three patients were included in the analysis: 54 (74.0%) with bacteraemia caused by E. faecalis and 19 (26.0%) by E. faecium. The Simplified Acute Physiological Score (SAPS) value was significantly greater in E. faecium isolates (40.7 vs. 35.2; p = 0.009). Diabetes mellitus was more frequently diagnosed in patients with E. faecium bacteraemia (52.6% vs. 24.1%; p = 0.021). Prior penicillin exposure was more frequent in patients with E. faecium bacteraemia (68.4% vs. 29.6%; p = 0.003). There was a trend toward higher mortality in E. faecium bacteraemia patients (47.4% vs. 25.9%; p = 0.084). Independent patient risk factors for E. faecium isolation were prior penicillin exposure (odds ratio [OR], 6.479; p = 0.003) and SAPS > 34 (OR, 6.896; p = 0.009). When compared to E. faecalis bacteraemia, E. faecium bacteraemia in cancer patients is independently associated with more severe illness and prior use of penicillins; therefore, empiric treatment which would cover E. faecium should be considered in cancer patients suspected of having bacteraemia.