DIFFERENCES IN OUTCOMES FOR PATIENTS WITH BACTEREMIA DUE TO VANCOMYCIN-RESISTANT ENTEROCOCCUS-FAECIUM OR VANCOMYCIN-SUSCEPTIBLE E-FAECIUM

To determine the differences in outcome in cases of enterococcal bacte remia due to vancomycin-resistant organisms, we compared consecutive p atients on a liver transplant service who had clinically significant b acteremia due to vancomycin-resistant Enterococcus faecium (VREF) (n = 54) with a contemporaneous cohort of patients who had vancomycin-susc eptible E, faecium (VSEF) bacteremia (n = 48). VREF bacteremia occurre d significantly later in the hospitalization than did VSEF bacteremia (43 days vs, 24 days, respectively; P < .01); in addition, VREF was mo re frequently the sole blood pathogen isolated (91% of patients) than was VSEF (56% of patients) (P = .0002), Invasive interventions for int raabdominal and intrathoracic infection were required more often in th e VREF cohort than in the VSEF cohort (34 of 45 patients vs, 20 of 41 patients, respectively; P = .01), Vancomycin resistance more frequentl y resulted in recurrent bacteremia (22 of 54 patients infected with VR EF vs, 7 of 48 patients infected with VSEF; P = .006), persistent isol ation of Enterococcus species at the primary site (27 of 33 patients i nfected with VREF vs, 7 of 18 patients infected with VSEF; P = .005), and endovascular infection (4 patients infected with VREF vs, none inf ected with VSEF). The decrement in patient survival, as measured from the last bacteremic episode, was greater in the VREF cohort (P = .02), Vancomycin resistance, shock, and liver failure were independent risk factors for Enterococcus-associated mortality. Higher rates of refrac tory infection, serious morbidity, and attributable death occurred in the VREF cohort and were partially mediated by the lack of effective a ntimicrobial therapy.