Risk Factors for the Acquisition of <i>Enterococcus faecium</i> Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital
The incidence of bacteremia caused by <i>Enterococcus faecium</i>, which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of <i>E. faecium</i> infection and mortality due to enterococcal bacteremia are not well kno...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-01-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/10/1/64 |
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| author | Atsushi Uda Katsumi Shigemura Koichi Kitagawa Kayo Osawa Kenichiro Onuma Yonmin Yan Tatsuya Nishioka Masato Fujisawa Ikuko Yano Takayuki Miyara |
| author_facet | Atsushi Uda Katsumi Shigemura Koichi Kitagawa Kayo Osawa Kenichiro Onuma Yonmin Yan Tatsuya Nishioka Masato Fujisawa Ikuko Yano Takayuki Miyara |
| author_sort | Atsushi Uda |
| collection | DOAJ |
| description | The incidence of bacteremia caused by <i>Enterococcus faecium</i>, which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of <i>E. faecium</i> infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiological, and clinical characteristics using a Cox regression model and univariate analysis. We performed a multivariate analysis to identify risk factors for patients treated between 2014 and 2018. Among 186 patients with enterococcal bacteremia, two groups included in the Kaplan–Meier analysis (<i>E. faecalis</i> (n = 88) and <i>E. faecium</i> (n = 94)) showed poor overall survival in the <i>E. faecium</i> group (HR: 1.92; 95% confidence interval: 1.01–3.66; <i>p</i> = 0.048). The median daily antibiotic cost per patient in the <i>E. faecium</i> group was significantly higher than that in the <i>E. faecalis</i> group ($23 ($13–$34) vs. $34 ($22–$58), <i>p</i> < 0.001). <i>E. faecium</i> strains were more frequently identified with previous use of antipseudomonal penicillins (OR = 4.04, <i>p</i> < 0.001) and carbapenems (OR = 3.33, <i>p</i> = 0.003). Bacteremia from an unknown source (OR = 2.79, <i>p</i> = 0.025) and acute kidney injury (OR = 4.51, <i>p</i> = 0.004) were associated with higher risks of 30-day mortality in patients with enterococcal bacteremia. Therefore, clinicians should provide improved medical management, with support from specialized teams such as those assisting antimicrobial stewardship programs. |
| first_indexed | 2024-03-09T05:17:53Z |
| format | Article |
| id | doaj.art-236291856b9d4d79a850c7a798eb740d |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T05:17:53Z |
| publishDate | 2021-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-236291856b9d4d79a850c7a798eb740d2023-12-03T12:43:38ZengMDPI AGAntibiotics2079-63822021-01-011016410.3390/antibiotics10010064Risk Factors for the Acquisition of <i>Enterococcus faecium</i> Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University HospitalAtsushi Uda0Katsumi Shigemura1Koichi Kitagawa2Kayo Osawa3Kenichiro Onuma4Yonmin Yan5Tatsuya Nishioka6Masato Fujisawa7Ikuko Yano8Takayuki Miyara9Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, JapanDepartment of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, JapanDivision of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, JapanDepartment of Medical Technology, Kobe Tokiwa University, Kobe 653-0838, JapanDepartment of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, JapanDivision of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, JapanDepartment of Pharmacy, Kobe University Hospital, Kobe 650-0017, JapanDivision of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, JapanDepartment of Pharmacy, Kobe University Hospital, Kobe 650-0017, JapanDepartment of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, JapanThe incidence of bacteremia caused by <i>Enterococcus faecium</i>, which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of <i>E. faecium</i> infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiological, and clinical characteristics using a Cox regression model and univariate analysis. We performed a multivariate analysis to identify risk factors for patients treated between 2014 and 2018. Among 186 patients with enterococcal bacteremia, two groups included in the Kaplan–Meier analysis (<i>E. faecalis</i> (n = 88) and <i>E. faecium</i> (n = 94)) showed poor overall survival in the <i>E. faecium</i> group (HR: 1.92; 95% confidence interval: 1.01–3.66; <i>p</i> = 0.048). The median daily antibiotic cost per patient in the <i>E. faecium</i> group was significantly higher than that in the <i>E. faecalis</i> group ($23 ($13–$34) vs. $34 ($22–$58), <i>p</i> < 0.001). <i>E. faecium</i> strains were more frequently identified with previous use of antipseudomonal penicillins (OR = 4.04, <i>p</i> < 0.001) and carbapenems (OR = 3.33, <i>p</i> = 0.003). Bacteremia from an unknown source (OR = 2.79, <i>p</i> = 0.025) and acute kidney injury (OR = 4.51, <i>p</i> = 0.004) were associated with higher risks of 30-day mortality in patients with enterococcal bacteremia. Therefore, clinicians should provide improved medical management, with support from specialized teams such as those assisting antimicrobial stewardship programs.https://www.mdpi.com/2079-6382/10/1/64enterococcalbacteremiaepidemiologyrisk factorsmortalityantimicrobial stewardship |
| spellingShingle | Atsushi Uda Katsumi Shigemura Koichi Kitagawa Kayo Osawa Kenichiro Onuma Yonmin Yan Tatsuya Nishioka Masato Fujisawa Ikuko Yano Takayuki Miyara Risk Factors for the Acquisition of <i>Enterococcus faecium</i> Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital Antibiotics enterococcal bacteremia epidemiology risk factors mortality antimicrobial stewardship |
| title | Risk Factors for the Acquisition of <i>Enterococcus faecium</i> Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital |
| title_full | Risk Factors for the Acquisition of <i>Enterococcus faecium</i> Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital |
| title_fullStr | Risk Factors for the Acquisition of <i>Enterococcus faecium</i> Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital |
| title_full_unstemmed | Risk Factors for the Acquisition of <i>Enterococcus faecium</i> Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital |
| title_short | Risk Factors for the Acquisition of <i>Enterococcus faecium</i> Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital |
| title_sort | risk factors for the acquisition of i enterococcus faecium i infection and mortality in patients with enterococcal bacteremia a 5 year retrospective analysis in a tertiary care university hospital |
| topic | enterococcal bacteremia epidemiology risk factors mortality antimicrobial stewardship |
| url | https://www.mdpi.com/2079-6382/10/1/64 |
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