Vancomycin-resistant enterococcal bacteremia: Natural history and attributable mortality

被引:219
作者
Edmond, MB
Ober, JF
Dawson, JD
Weinbaum, DL
Wenzel, RP
机构
[1] VIRGINIA COMMONWEALTH UNIV, MED COLL VIRGINIA, DEPT INTERNAL MED, RICHMOND, VA 23298 USA
[2] WESTERN PENN HOSP, PITTSBURGH, PA 15224 USA
[3] UNIV IOWA, DEPT PREVENT MED, COLL MED, DIV BIOSTAT, IOWA CITY, IA 52242 USA
关键词
D O I
10.1093/clinids/23.6.1234
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Previous studies have shown that bacteremia due to vancomycin-resistant Enterococcus species (VRE) is associated with mortality of 17%-100%, but comorbid conditions may have confounded the estimates. We designed a historical cohort study to determine the mortality attributable to VRE bacteremia. Twenty-seven patients with VRE bacteremia were identified as cases. Within 7 days of the onset of bacteremia, severe sepsis developed in 12 patients (44%) and septic shock developed in 10 (37%). Case patients were closely matched to control patients without VRE bacteremia (1:1) by time of hospitalization, duration of exposure, underlying disease, age, gender, and surgical procedure. The mortality was 67% among cases and 30% among matched controls (P = .01). Thus, the mortality attributable to VRE bacteremia was 37% (95% confidence interval [CI], 10%-64%) and the risk ratio for death was 2.3 (CI, 1.2-4.1). We conclude that VRE bacteremia is associated with high rates of severe sepsis and septic shock. The attributable mortality approaches 40%, and patients who have VRE bacteremia are twice as likely to die than closely matched controls.
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页码:1234 / 1239
页数:6
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