RISK-FACTORS FOR MORTALITY ASSOCIATED WITH ENTEROCOCCAL BLOOD-STREAM INFECTIONS

OBJECTIVE: To determine risk factors for mortality in patients with a nosocomial enterococcal primary bloodstream infection (EPBI) and to as sess whether vancomycin resistance placed a patient at increased risk of death. DESIGN/SETTING: A retrospective cohort study was conducted i n four National Nosocomial Infection Surveillance System hospitals. RE SULTS: Of 145 patients identified with EPBIs, 74 (51%) died, and 26 (1 8%) had a vancomycin-resistant isolate. Upon comparing patients with E PBIs who survived to those who died, no associations were found betwee n mortality and prior invasive device use, procedure history, type or number of prior nosocomial infections, length of hospitalization befor e infection, or receipt vancomycin. Independent predictors of mortalit y were indices of severity of illness (APACHE II score and comorbidity weighted index), age, the use of third-generation cephalosporins or m etronidazole during the week prior to infection, and female gender. CO NCLUSIONS: Vancomycin resistance was not an independent predictor of d eath, and its role was difficult to establish, because cohort patients were among the most severely ill of all hospitalized patients. Entero coccal primary bloodstream infections appear to indicate severe, life- threatening disease processes. The pathogenicity of enterococci and th e role of vancomycin resistance as a cause of mortality in patients wi th EPBIs need to be assessed further.