Attributable mortality of vancomycin resistance in ampicillin-resistant Enterococcus faecium bacteremia in Denmark and the Netherlands: A matched cohort study.

Autor:	Rottier WC; Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands., Pinholt M; Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark.; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., van der Bij AK; Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., Arpi M; Department of Clinical Microbiology, Herlev University Hospital, Herlev, Denmark., Blank SN; Department of Internal Medicine, Maxima Medical Center, Eindhoven/Veldhoven, The Netherlands., Nabuurs-Franssen MH; Department of Medical Microbiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands., Ruijs GJHM; Laboratory for Clinical Microbiology and Infectious Diseases, Isala, Zwolle, The Netherlands., Tersmette M; Department of Medical Microbiology and Immunology, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands., Ossewaarde JM; Department of Medical Microbiology, Maasstad Ziekenhuis, Rotterdam, The Netherlands., Groenwold RH; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands., Westh H; Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark.; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark., Bonten MJM; Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Infection control and hospital epidemiology [Infect Control Hosp Epidemiol] 2022 Jun; Vol. 43 (6), pp. 719-727. Date of Electronic Publication: 2021 Jun 21.
DOI:	10.1017/ice.2021.216
Abstrakt:	Objective: To study whether replacement of nosocomial ampicillin-resistant Enterococcus faecium (ARE) clones by vancomycin-resistant E. faecium (VRE), belonging to the same genetic lineages, increases mortality in patients with E. faecium bacteremia, and to evaluate whether any such increase is mediated by a delay in appropriate antibiotic therapy. Design: Retrospective, matched-cohort study. Setting: The study included 20 Dutch and Danish hospitals from 2009 to 2014. Patients: Within the study period, 63 patients with VRE bacteremia (36 Dutch and 27 Danish) were identified and subsequently matched to 234 patients with ARE bacteremia (130 Dutch and 104 Danish) for hospital, ward, length of hospital stay prior to bacteremia, and age. For all patients, 30-day mortality after bacteremia onset was assessed. Methods: The risk ratio (RR) reflecting the impact of vancomycin resistance on 30-day mortality was estimated using Cox regression with further analytic control for confounding factors. Results: The 30-day mortality rates were 27% and 38% for ARE in the Netherlands and Denmark, respectively, and the 30-day mortality rates were 33% and 48% for VRE in these respective countries. The adjusted RR for 30-day mortality for VRE was 1.54 (95% confidence interval, 1.06-2.25). Although appropriate antibiotic therapy was initiated later for VRE than for ARE bacteremia, further analysis did not reveal mediation of the increased mortality risk. Conclusions: Compared to ARE bacteremia, VRE bacteremia was associated with higher 30-day mortality. One explanation for this association would be increased virulence of VRE, although both phenotypes belong to the same well-characterized core genomic lineage. Alternatively, it may be the result of unmeasured confounding.
Databáze:	MEDLINE
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