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Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital

The incidence of bacteremia caused by Enterococcus faecium, which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of E. faecium infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiol...

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Autores principales: Uda, Atsushi, Shigemura, Katsumi, Kitagawa, Koichi, Osawa, Kayo, Onuma, Kenichiro, Yan, Yonmin, Nishioka, Tatsuya, Fujisawa, Masato, Yano, Ikuko, Miyara, Takayuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826794/
https://www.ncbi.nlm.nih.gov/pubmed/33440660
http://dx.doi.org/10.3390/antibiotics10010064
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author Uda, Atsushi
Shigemura, Katsumi
Kitagawa, Koichi
Osawa, Kayo
Onuma, Kenichiro
Yan, Yonmin
Nishioka, Tatsuya
Fujisawa, Masato
Yano, Ikuko
Miyara, Takayuki
author_facet Uda, Atsushi
Shigemura, Katsumi
Kitagawa, Koichi
Osawa, Kayo
Onuma, Kenichiro
Yan, Yonmin
Nishioka, Tatsuya
Fujisawa, Masato
Yano, Ikuko
Miyara, Takayuki
author_sort Uda, Atsushi
collection PubMed
description The incidence of bacteremia caused by Enterococcus faecium, which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of E. faecium infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiological, and clinical characteristics using a Cox regression model and univariate analysis. We performed a multivariate analysis to identify risk factors for patients treated between 2014 and 2018. Among 186 patients with enterococcal bacteremia, two groups included in the Kaplan–Meier analysis (E. faecalis (n = 88) and E. faecium (n = 94)) showed poor overall survival in the E. faecium group (HR: 1.92; 95% confidence interval: 1.01–3.66; p = 0.048). The median daily antibiotic cost per patient in the E. faecium group was significantly higher than that in the E. faecalis group ($23 ($13–$34) vs. $34 ($22–$58), p < 0.001). E. faecium strains were more frequently identified with previous use of antipseudomonal penicillins (OR = 4.04, p < 0.001) and carbapenems (OR = 3.33, p = 0.003). Bacteremia from an unknown source (OR = 2.79, p = 0.025) and acute kidney injury (OR = 4.51, p = 0.004) were associated with higher risks of 30-day mortality in patients with enterococcal bacteremia. Therefore, clinicians should provide improved medical management, with support from specialized teams such as those assisting antimicrobial stewardship programs.
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spelling pubmed-78267942021-01-25 Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital Uda, Atsushi Shigemura, Katsumi Kitagawa, Koichi Osawa, Kayo Onuma, Kenichiro Yan, Yonmin Nishioka, Tatsuya Fujisawa, Masato Yano, Ikuko Miyara, Takayuki Antibiotics (Basel) Article The incidence of bacteremia caused by Enterococcus faecium, which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of E. faecium infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiological, and clinical characteristics using a Cox regression model and univariate analysis. We performed a multivariate analysis to identify risk factors for patients treated between 2014 and 2018. Among 186 patients with enterococcal bacteremia, two groups included in the Kaplan–Meier analysis (E. faecalis (n = 88) and E. faecium (n = 94)) showed poor overall survival in the E. faecium group (HR: 1.92; 95% confidence interval: 1.01–3.66; p = 0.048). The median daily antibiotic cost per patient in the E. faecium group was significantly higher than that in the E. faecalis group ($23 ($13–$34) vs. $34 ($22–$58), p < 0.001). E. faecium strains were more frequently identified with previous use of antipseudomonal penicillins (OR = 4.04, p < 0.001) and carbapenems (OR = 3.33, p = 0.003). Bacteremia from an unknown source (OR = 2.79, p = 0.025) and acute kidney injury (OR = 4.51, p = 0.004) were associated with higher risks of 30-day mortality in patients with enterococcal bacteremia. Therefore, clinicians should provide improved medical management, with support from specialized teams such as those assisting antimicrobial stewardship programs. MDPI 2021-01-11 /pmc/articles/PMC7826794/ /pubmed/33440660 http://dx.doi.org/10.3390/antibiotics10010064 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Uda, Atsushi
Shigemura, Katsumi
Kitagawa, Koichi
Osawa, Kayo
Onuma, Kenichiro
Yan, Yonmin
Nishioka, Tatsuya
Fujisawa, Masato
Yano, Ikuko
Miyara, Takayuki
Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital
title Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital
title_full Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital
title_fullStr Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital
title_full_unstemmed Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital
title_short Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital
title_sort risk factors for the acquisition of enterococcus faecium infection and mortality in patients with enterococcal bacteremia: a 5-year retrospective analysis in a tertiary care university hospital
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826794/
https://www.ncbi.nlm.nih.gov/pubmed/33440660
http://dx.doi.org/10.3390/antibiotics10010064
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