Comparison of morbidity and mortality after bloodstream infection with vancomycin-resistant versus -susceptible Enterococcus faecium: a nationwide cohort study in Denmark, 2010-2019

• Published in: Emerging microbes & infections Vol. 13; no. 1; p. 2309969
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01.12.2024; Taylor & Francis Group
• Subjects: antimicrobial resistance; Cohort Studies; Denmark - epidemiology; Enterococci; Enterococcus; Enterococcus faecium; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - epidemiology; Humans; Morbidity; mortality; nosocomial; Sepsis; Vancomycin; Denmark; mortality; vancomycin; nosocomial; morbidity; Enterococci; antimicrobial resistance
• ISSN: 2222-1751; 2222-1751
• DOI: 10.1080/22221751.2024.2309969

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 -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 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 (  = 0.14) or discharge (  = 0.45) after VRE compared to VSE, despite longer time for VRE patients (17 vs. 10 days for VSE,  < 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 BSI warrants further study.