ENTEROCOCCUS-FAECIUM AND ENTEROCOCCUS-FAECALIS BACTEREMIA - ACQUISITION AND OUTCOME

The incidence of enterococcal bacteremia due to Enterococcus faecium i s increasing. To understand the clinical significance of E. faecium ba cteremia, we compared 16 patients who were bacteremic due to E. faeciu m to 56 patients who were bacteremic due to Enterococcus faecalis. E. faecium bacteremia developed most frequently in severely ill patients with fever or hypothermia accompanied by CNS, cardiovascular, and/or p ulmonary dysfunction, while E. faecalis bacteremia occurred most often in less seriously ill patients. Nosocomial acquisition, cancer, neutr openia, renal insufficiency, current corticosteroid therapy, and previ ous treatment with broad-spectrum antibiotics were significantly more frequently associated with E. faecium bacteremia. Mortality was signif icantly higher among patients infected with E. faecium than among thos e infected with E. faecalis (50% vs, 11%; P = .001); this was true par ticularly among patients with monomicrobial or nosocomial bacteremia, those who had previously received antibiotic treatment, and those with cancer. Death due to enterococcal bacteremia was observed only among severely ill patients. These findings suggest that E. faecium often in fects debilitated patients and that such infection appears to be a sig nificant factor contributing to mortality.