Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?—The Munich multicentric enterococci cohort
ABSTRACT To assess the long-term survival of patients with enterococcal bloodstream infections (BSI), encompassing various species and resistance patterns compared to Escherichia coli (E. coli) BSI. Between 2010–2019, 3,290 enterococcal and 3,415 E. coli BSI were retrospectively screened in seven ho...
| Principais autores: | , , , , , , , , , , , , , , , , , , |
|---|---|
| Formato: | Artigo |
| Idioma: | English |
| Publicado em: |
American Society for Microbiology
2023-12-01
|
| coleção: | Microbiology Spectrum |
| Assuntos: | |
| Acesso em linha: | https://journals.asm.org/doi/10.1128/spectrum.02585-23 |
| _version_ | 1827586693577834496 |
|---|---|
| author | Kathrin Rothe Tobias Bachfischer Siranush Karapetyan Alexander Hapfelmeier Milena Wurst Sabine Gleich Karl Dichtl Roland M. Schmid Julian Triebelhorn Laura Wagner Johanna Erber Florian Voit Rainer Burgkart Andreas Obermeier Ulrich Seibold Dirk H. Busch Patrick C. Rämer Christoph D. Spinner Jochen Schneider |
| author_facet | Kathrin Rothe Tobias Bachfischer Siranush Karapetyan Alexander Hapfelmeier Milena Wurst Sabine Gleich Karl Dichtl Roland M. Schmid Julian Triebelhorn Laura Wagner Johanna Erber Florian Voit Rainer Burgkart Andreas Obermeier Ulrich Seibold Dirk H. Busch Patrick C. Rämer Christoph D. Spinner Jochen Schneider |
| author_sort | Kathrin Rothe |
| collection | DOAJ |
| description | ABSTRACT To assess the long-term survival of patients with enterococcal bloodstream infections (BSI), encompassing various species and resistance patterns compared to Escherichia coli (E. coli) BSI. Between 2010–2019, 3,290 enterococcal and 3,415 E. coli BSI were retrospectively screened in seven hospitals in Munich, Germany. All vancomycin-resistant (VRE), vancomycin/linezolid-resistant (LVRE), and linezolid-resistant (LRE) Enterococcus faecium (ECFM) BSI were included. Enterococcus faecalis (ECFA), vancomycin/linezolid-susceptible ECFM, and E. coli BSI were randomly assigned. Cox regression analysis was used to assess survival as the primary endpoint and was adjusted for limiting prognostic factors, which were measured for their importance using a random forest model (RFM). We analyzed 952 patients with 916 episodes of enterococcal BSI and 193 episodes of E. coli BSI. RFM identified multimorbidity and markers for disease severity as most indicative of low survival in enterococcal BSI. The 5-year survival was significantly lower for enterococcal BSI than for E. coli BSI (23.9% vs 42.3%; P < 0.001). This difference remained significant in the Cox regression analysis after adjusting for 17 prognostic factors and excluding patients with limited life expectancy (metastatic tumor disease, Charlson-Comorbidity-Index ≥5). Adjusted 5-year survival was similar for E. coli and ECFA but significantly different between ECFA and ECFM (29.2% vs 21.7%; P = 0.002). The analysis conducted on monomicrobial ECFM and VRE BSI indicated that their respective 5-year survival was similar (19.6% vs. 21.2%; P = 0.753). ECFM BSI seems to be an independent risk factor for poor long-term survival. However, additional vancomycin resistance does not appear to be a contributing factor. IMPORTANCE The present study provides a substantial contribution to literature, showing that patients with enterococcal bloodstream infections (BSI) have a lower survival rate than those with Escherichia coli (E. coli) bloodstream infections after adjusting for 17 limiting prognostic factors and excluding patients with a limited life expectancy [metastatic tumor disease, Charlson Comorbidity Index (CCI) (greater than or equal to) 5]. This difference in the 5-year long-term survival was mainly driven by Enterococcus faecium (ECFM) bloodstream infections, with vancomycin resistance not being a significant contributing factor. Our findings imply that E. faecium bloodstream infections seem to be an independent risk factor for poor long-term outcomes. As such, future research should confirm this relationship and prioritize investigating its causality through prospective studies. |
| first_indexed | 2024-03-09T00:06:36Z |
| format | Article |
| id | doaj.art-bc7d4dcab81e413ba1f1e5a3a05018ec |
| institution | Directory Open Access Journal |
| issn | 2165-0497 |
| language | English |
| last_indexed | 2024-03-09T00:06:36Z |
| publishDate | 2023-12-01 |
| publisher | American Society for Microbiology |
| record_format | Article |
| series | Microbiology Spectrum |
| spelling | doaj.art-bc7d4dcab81e413ba1f1e5a3a05018ec2023-12-12T13:17:20ZengAmerican Society for MicrobiologyMicrobiology Spectrum2165-04972023-12-0111610.1128/spectrum.02585-23Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?—The Munich multicentric enterococci cohortKathrin Rothe0Tobias Bachfischer1Siranush Karapetyan2Alexander Hapfelmeier3Milena Wurst4Sabine Gleich5Karl Dichtl6Roland M. Schmid7Julian Triebelhorn8Laura Wagner9Johanna Erber10Florian Voit11Rainer Burgkart12Andreas Obermeier13Ulrich Seibold14Dirk H. Busch15Patrick C. Rämer16Christoph D. Spinner17Jochen Schneider18Institute for Medical Microbiology, Immunology and Hygiene, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyDepartment of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyInstitute of General Practice and Health Services Research, University Hospital rechts der Isar, School of Medicine, Technical University of Munich , Munich, GermanyInstitute of General Practice and Health Services Research, University Hospital rechts der Isar, School of Medicine, Technical University of Munich , Munich, GermanyDepartment of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyPublic Health Service , City of Munich, Munich, GermanyMax von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, Ludwig-Maximilians-Universität München , Munich, GermanyDepartment of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyDepartment of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyDepartment of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyDepartment of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyDepartment of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyClinic of Orthopaedics and Sports Orthopaedics, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyClinic of Orthopaedics and Sports Orthopaedics, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyGerman Centre for Infection Research (DZIF), partner site Munich , Munich, GermanyInstitute for Medical Microbiology, Immunology and Hygiene, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyDepartment of Hospital Hygiene and Infection Control, Munich Municipal Hospital Group , Munich, GermanyDepartment of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyDepartment of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, GermanyABSTRACT To assess the long-term survival of patients with enterococcal bloodstream infections (BSI), encompassing various species and resistance patterns compared to Escherichia coli (E. coli) BSI. Between 2010–2019, 3,290 enterococcal and 3,415 E. coli BSI were retrospectively screened in seven hospitals in Munich, Germany. All vancomycin-resistant (VRE), vancomycin/linezolid-resistant (LVRE), and linezolid-resistant (LRE) Enterococcus faecium (ECFM) BSI were included. Enterococcus faecalis (ECFA), vancomycin/linezolid-susceptible ECFM, and E. coli BSI were randomly assigned. Cox regression analysis was used to assess survival as the primary endpoint and was adjusted for limiting prognostic factors, which were measured for their importance using a random forest model (RFM). We analyzed 952 patients with 916 episodes of enterococcal BSI and 193 episodes of E. coli BSI. RFM identified multimorbidity and markers for disease severity as most indicative of low survival in enterococcal BSI. The 5-year survival was significantly lower for enterococcal BSI than for E. coli BSI (23.9% vs 42.3%; P < 0.001). This difference remained significant in the Cox regression analysis after adjusting for 17 prognostic factors and excluding patients with limited life expectancy (metastatic tumor disease, Charlson-Comorbidity-Index ≥5). Adjusted 5-year survival was similar for E. coli and ECFA but significantly different between ECFA and ECFM (29.2% vs 21.7%; P = 0.002). The analysis conducted on monomicrobial ECFM and VRE BSI indicated that their respective 5-year survival was similar (19.6% vs. 21.2%; P = 0.753). ECFM BSI seems to be an independent risk factor for poor long-term survival. However, additional vancomycin resistance does not appear to be a contributing factor. IMPORTANCE The present study provides a substantial contribution to literature, showing that patients with enterococcal bloodstream infections (BSI) have a lower survival rate than those with Escherichia coli (E. coli) bloodstream infections after adjusting for 17 limiting prognostic factors and excluding patients with a limited life expectancy [metastatic tumor disease, Charlson Comorbidity Index (CCI) (greater than or equal to) 5]. This difference in the 5-year long-term survival was mainly driven by Enterococcus faecium (ECFM) bloodstream infections, with vancomycin resistance not being a significant contributing factor. Our findings imply that E. faecium bloodstream infections seem to be an independent risk factor for poor long-term outcomes. As such, future research should confirm this relationship and prioritize investigating its causality through prospective studies.https://journals.asm.org/doi/10.1128/spectrum.02585-23enteroccocal bloodstream infections5-year survivalEnterococcus faeciumvancomycin resistant Entercoccus faeciumdisease severity |
| spellingShingle | Kathrin Rothe Tobias Bachfischer Siranush Karapetyan Alexander Hapfelmeier Milena Wurst Sabine Gleich Karl Dichtl Roland M. Schmid Julian Triebelhorn Laura Wagner Johanna Erber Florian Voit Rainer Burgkart Andreas Obermeier Ulrich Seibold Dirk H. Busch Patrick C. Rämer Christoph D. Spinner Jochen Schneider Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?—The Munich multicentric enterococci cohort Microbiology Spectrum enteroccocal bloodstream infections 5-year survival Enterococcus faecium vancomycin resistant Entercoccus faecium disease severity |
| title | Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?—The Munich multicentric enterococci cohort |
| title_full | Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?—The Munich multicentric enterococci cohort |
| title_fullStr | Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?—The Munich multicentric enterococci cohort |
| title_full_unstemmed | Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?—The Munich multicentric enterococci cohort |
| title_short | Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?—The Munich multicentric enterococci cohort |
| title_sort | are enterococcal bloodstream infections an independent risk factor for a poorer 5 year survival or just a marker for severity of illness the munich multicentric enterococci cohort |
| topic | enteroccocal bloodstream infections 5-year survival Enterococcus faecium vancomycin resistant Entercoccus faecium disease severity |
| url | https://journals.asm.org/doi/10.1128/spectrum.02585-23 |
| work_keys_str_mv | AT kathrinrothe areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT tobiasbachfischer areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT siranushkarapetyan areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT alexanderhapfelmeier areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT milenawurst areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT sabinegleich areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT karldichtl areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT rolandmschmid areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT juliantriebelhorn areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT laurawagner areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT johannaerber areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT florianvoit areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT rainerburgkart areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT andreasobermeier areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT ulrichseibold areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT dirkhbusch areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT patrickcramer areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT christophdspinner areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort AT jochenschneider areenterococcalbloodstreaminfectionsanindependentriskfactorforapoorer5yearsurvivalorjustamarkerforseverityofillnessthemunichmulticentricenterococcicohort |