An analysis of treatment of patients with vancomycin-resistant enterococcal bacteremia

Vancomycin-resistant enterococci (VRE) have become a major cause of nosocomial infections. If the organism is resistant or the patient is allergic to penicillin, proven therapy does not exist. To evaluate the treatment of patients with vancomycin-resistant enterococcal bacteremia (VREB), we reviewed the therapy for 69 patients With VREB at 13 New Jersey hospitals that had five or more cases of VREB. Prior treatment oi these patients with vancomycin was common. Susceptibility patterns varied according to the hospital, and clinicians employed many different combinations of antimicrobial agents to treat these infections. Lower mortality rates (34% vs. 61%, P =.031; 95% Cl -49.8% to -4.2%) were achieved in patients who received al least one antimicrobial agent to which their organism was susceptible. Overall, mortality was 46%, and of these deaths, 72% were judged to be directly related to VREB. Optimal therapy remains to be determined.