Comparison of morbidity and mortality after bloodstream infection with vancomycin-resistant versus -susceptible Enterococcus faecium: a nationwide cohort study in Denmark, 2010–2019
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Comparison of morbidity and mortality after bloodstream infection with vancomycin-resistant versus -susceptible Enterococcus faecium : a nationwide cohort study in Denmark, 2010–2019. / Bager, Peter; Kähler, Jonas; Andersson, Mikael; Holzknecht, Barbara Juliane; Kjær Hansen, Sanne Grønvall; Schønning, Kristian; Nielsen, Karen Leth; Koch, Kristoffer; Pinholt, Mette; Voldstedlund, Marianne; Larsen, Anders Rhod; Kristensen, Brian; Mølbak, Kåre; Sönksen, Ute Wolff; Skovgaard, Sissel; Skov, Robert; Hammerum, Anette M.
In: Emerging Microbes and Infections, Vol. 13, No. 1, 2309969, 2024.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Comparison of morbidity and mortality after bloodstream infection with vancomycin-resistant versus -susceptible Enterococcus faecium
T2 - a nationwide cohort study in Denmark, 2010–2019
AU - Bager, Peter
AU - Kähler, Jonas
AU - Andersson, Mikael
AU - Holzknecht, Barbara Juliane
AU - Kjær Hansen, Sanne Grønvall
AU - Schønning, Kristian
AU - Nielsen, Karen Leth
AU - Koch, Kristoffer
AU - Pinholt, Mette
AU - Voldstedlund, Marianne
AU - Larsen, Anders Rhod
AU - Kristensen, Brian
AU - Mølbak, Kåre
AU - Sönksen, Ute Wolff
AU - Skovgaard, Sissel
AU - Skov, Robert
AU - Hammerum, Anette M.
N1 - Publisher Copyright: © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group, on behalf of Shanghai Shangyixun Cultural Communication Co., Ltd.
PY - 2024
Y1 - 2024
N2 - The emergence of bloodstream infections (BSI) caused by vancomycin-resistant Enterococci (VRE) has caused concern. Nonetheless, it remains unclear whether these types are associated with an excess risk of severe outcomes when compared with infections caused by vancomycin-susceptible Enterococci (VSE). This cohort study included hospitalized patients in Denmark with Enterococcus faecium-positive blood cultures collected between 2010 and 2019 identified in the Danish Microbiology Database. We estimated 30-day hazard ratio (HR) of death or discharge among VRE compared to VSE patients adjusted for age, sex, and comorbidity. The cohort included 6071 patients with E. faecium BSI (335 VRE, 5736 VSE) among whom VRE increased (2010–13, 2.6%; 2014–16, 6.3%; 2017–19; 9.4%). Mortality (HR 1.08, 95%CI 0.90–1.29; 126 VRE, 37.6%; 2223 VSE, 37.0%) or discharge (HR 0.89, 95%CI 0.75–1.06; 126 VRE, 37.6%; 2386 VSE, 41.6%) was not different between VRE and VSE except in 2014 (HR 1.87, 95% CI 1.18–2.96). There was no interaction between time from admission to BSI (1–2, 3–14, and >14 days) and HR of death (P = 0.14) or discharge (P = 0.45) after VRE compared to VSE, despite longer time for VRE patients (17 vs. 10 days for VSE, P < 0.0001). In conclusion, VRE BSI was not associated with excess morbidity and mortality. The excess mortality in 2014 only may be attributed to improved diagnostic- and patient-management practices after 2014, reducing time to appropriate antibiotic therapy. The high level of mortality after E. faecium BSI warrants further study.
AB - The emergence of bloodstream infections (BSI) caused by vancomycin-resistant Enterococci (VRE) has caused concern. Nonetheless, it remains unclear whether these types are associated with an excess risk of severe outcomes when compared with infections caused by vancomycin-susceptible Enterococci (VSE). This cohort study included hospitalized patients in Denmark with Enterococcus faecium-positive blood cultures collected between 2010 and 2019 identified in the Danish Microbiology Database. We estimated 30-day hazard ratio (HR) of death or discharge among VRE compared to VSE patients adjusted for age, sex, and comorbidity. The cohort included 6071 patients with E. faecium BSI (335 VRE, 5736 VSE) among whom VRE increased (2010–13, 2.6%; 2014–16, 6.3%; 2017–19; 9.4%). Mortality (HR 1.08, 95%CI 0.90–1.29; 126 VRE, 37.6%; 2223 VSE, 37.0%) or discharge (HR 0.89, 95%CI 0.75–1.06; 126 VRE, 37.6%; 2386 VSE, 41.6%) was not different between VRE and VSE except in 2014 (HR 1.87, 95% CI 1.18–2.96). There was no interaction between time from admission to BSI (1–2, 3–14, and >14 days) and HR of death (P = 0.14) or discharge (P = 0.45) after VRE compared to VSE, despite longer time for VRE patients (17 vs. 10 days for VSE, P < 0.0001). In conclusion, VRE BSI was not associated with excess morbidity and mortality. The excess mortality in 2014 only may be attributed to improved diagnostic- and patient-management practices after 2014, reducing time to appropriate antibiotic therapy. The high level of mortality after E. faecium BSI warrants further study.
KW - antimicrobial resistance
KW - Enterococci
KW - morbidity
KW - mortality
KW - nosocomial
KW - vancomycin
U2 - 10.1080/22221751.2024.2309969
DO - 10.1080/22221751.2024.2309969
M3 - Journal article
C2 - 38258968
AN - SCOPUS:85187411685
VL - 13
JO - Emerging Microbes and Infections
JF - Emerging Microbes and Infections
SN - 2222-1751
IS - 1
M1 - 2309969
ER -
ID: 385698907