Emergence of vancomycin-resistant Enterococcus bloodstream infections in southern Taiwan

BackgroundAn increased incidence of vancomycin-resistant enterococcal bloodstream infections (VRE BSI) in the United States has been noted in recent years. There were a few reports of VRE BSI in Taiwan. This study is intended to show the epidemiology, clinical features and outcomes of VRE BSI at a medical center in southern Taiwan.MethodsA retrospective study was conducted from January 1, 2005 to December 31, 2010. All patients with VRE BSI episodes were identified and their medical records were reviewed.ResultsA total of 69 episodes of VRE BSI were identified in the study period. The incidence rate increased from 0.01 episodes of VRE BSI/1000 patient-days in 2005 to 0.07 episodes of VRE BSI/1000 patient-days in 2010. The 30-day mortality rate was 52.17% for all patients with VRE BSI. The mortality rate of patients who received in vitro active and inactive antimicrobial therapy for VRE BSI was 40% and 100%, respectively (p < 0.001). Factors associated with mortality were shock [odds ratio (OR) 24.4, 95% confidence interval (CI) 3.6–163.2, p = 0.001], renal failure (OR 90.9, 95% CI 1.9–4404.3, p = 0.02), and underlying liver cirrhosis (OR 12.4, 95% CI 1.2–125.8, p = 0.03). Use of linezolid for VRE BSI showed a trend for lower 30-day mortality than daptomycin therapy (35.5% vs. 56.3%, p = 0.17).ConclusionVRE BSI is increasingly important in the study hospital and is associated with a significant mortality rate. Appropriateness of antimicrobial therapy has a prognostic impact on patients with VRE BSI.