Risk factors for mortality in patients with vancomycin-resistant enterococcus bloodstream infection

• Main Author: Hjalmarson, Karin I
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2010
• Subjects: Medicine
• ISBN: 1124021132; 9781124021133

Background. The prevalence of Vancomycin-Resistant Enterococcus (VRE) infections has increased rapidly over the last two decades. Bloodstream infection (BSI) with VRE has been shown to be an independent risk factor of mortality in several studies. Objective. We sought to identify and describe independent risk factors for shortterm mortality in patients with VRE BSI. Methods. We performed a retrospective cohort study of all patients with VRE BSI at two large academic medical centers from 2004-2008. The main outcome was two-week in-hospital mortality. The survivors and patients who died were compared with respect to demographical, clinical and microbiological factors. Statistical approaches and clinical judgment were used to build a multivariate logistic regression model, which identified variables that were most strongly associated with mortality from VRE BSI. Results. A total of 162 patients with VRE BSI were included in the analysis with a two-week in-hospital mortality rate of 34%. In multivariate models, risk factors independently associated with two-week in-hospital mortality in patients with VRE BSI were higher Apache II score (OR=1.12, [1.05-1.19]), McCabe score of rapidly fatal (OR=6.45, [2.14-19.44]) and Sepsis on the day of VRE BSI (OR=4.34, [1.55-12.20]). Independent predictors of 2-week in-hospital survival were weight more than 80 kg (OR=0.33, [0.14-0.77]), abdominal surgery within 2 weeks prior to VRE BSI (OR=0.13, [0.03-0.71]) and Hospital (OR=0.20, [0.08-0.50]). Conclusions. These findings suggest that in the two centers studied a higher severity of illness scores, specifically APACHE II, McCabe score and Sepsis, at the day of VRE BSI is associated with worse outcome while abdominal surgery and a higher weight at the time of BSI as well as location at one center were associated with a better outcome. Additional study is needed to validate and further explore these results.