mortality in enterococcal bloodstream infections increases with inappropriate antimicrobial therapy.
Clin Microbiol Infect. 2010 Oct 14;
Authors: Suppli M, Aabenhus R, Harboe ZB, Andersen LP, Tvede M, Jensen JU
Enterococcus species are common in nosocomial bloodstream infections and their incidence is rising. Although well recognized in several serious bacterial infections, the influence of appropriate antimicrobial therapy in enterococcal bacteremia has not been fully settled. The aim of the study was to determine whether administration of inappropriate antibiotics in enterococcal bacteremia is an independent risk factor of mortality, among other known and suspected risk factors. We conducted a cohort study of E. faecalis/ faecium bacteremia during a three-year period at a single tertiary care hospital in Denmark. Patients with growth of non-enterococcus co-pathogens apart from the enterococcal bacteremia were also included, as were patients with repeated enterococcal bacteremia. Time to adequate antimicrobial therapy was counted from the first episode.. Appropriate antibiotic therapy was defined as any therapy with proven clinical effect, in vitro susceptible and a minimum treatment length of six days. Multivariate regression models were built to determine the independent risk factors for mortality. We included 196 patients with enterococcal bacteremia. Appropriate antibiotics for at least six days was administered in 146 of these (74%). 30-day mortality in was 26%. Multivariate logistic regression identified independent predictors of 30-day all cause mortality: appropriate antimicrobial therapy for ?6 days (odds ratio for mortality 0.33 [0.14-0.79]), ICU-admission: 4.2 [1.7-10], Thrombocytopenia: 3.9 [1.6-9.3], Chronic liver failure: 3.3 [1.1-10] and Age ? 60 years: 2.2 [0.99-5.0]. Antibiotics not appropriately covering enterococci are frequently administered empirically in suspected bloodstream infections. Inappropriate antibiotic therapy was an independent risk factor of mortality in enterococcal bacteremia.
PMID: 20946408 [PubMed - as supplied by publisher]