Epidemiology of enterococcal bacteremia in a referral center for hepatobiliary diseases

Background: Enterococcus faecium (EFM) and Enterococcus faecalis (EFL) account for most infections which predominantly originate in the abdomen or the urinary tract. The objectives of this study were to com pa re the riskfactors associated with EFM and EFL bacteremia Patients and Method: Retrospective study of 64 EFL and 27 EFM bacteremia cases that occurred between January 1993 and December 1996 in a referral center for hepatobiliary diseases. Results: Univariate predictors of EFM bacteremia,, compared to EFL, were an orthoptic liver transplantation (OLT), use of steroids, admission in the hepatology service, a central vascular catheter and an abdominal source. Forward regression models identified OLT as the only independent risk factor for 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 = 0.0003). Molecular typing of EFM isolates identified four small nosocomial clusters (of two to seven patients each) of EFM bacteremia, involving primarily patients admitted to the intensive care unit or on the hepatology ward. Conclusion: Strategies are needed to prevent enterococcal bacteremia in patients with severe liver disease, especially those undergoing OLT.