Epidemiology of enterococcal bacteremia in a referral center for hepatobiliary diseases

Background: Enterococcus faecium (EFM) and Enterococcus faecalis (EFL) acco unt for most infections which predominantly originate in the abdomen or the urinary tract. The objectives of this study were to com pa re the riskfact ors associated with EFM and EFL bacteremia Patients and Method: Retrospective study of 64 EFL and 27 EFM bacteremia ca ses that occurred between January 1993 and December 1996 in a referral cent er for hepatobiliary diseases. Results: Univariate predictors of EFM bacteremia,, compared to EFL, were an orthoptic liver transplantation (OLT), use of steroids, admission in the h epatology service, a central vascular catheter and an abdominal source. For ward regression models identified OLT as the only independent risk factor f or EFM bacteremia (odds ratio, OR = 4.320; p = 0.0064), and septic shock as the only predictor of a fatal enterococcal bacteremia (OR =13.152; p = 0.0 003). Molecular typing of EFM isolates identified four small nosocomial clu sters (of two to seven patients each) of EFM bacteremia, involving primaril y patients admitted to the intensive care unit or on the hepatology ward. Conclusion: Strategies are needed to prevent enterococcal bacteremia in pat ients with severe liver disease, especially those undergoing OLT.