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
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- Atsushi Uda
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan
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- Katsumi Shigemura
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan
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- Koichi Kitagawa
- Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan
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- Kayo Osawa
- Department of Medical Technology, Kobe Tokiwa University, Kobe 653-0838, Japan
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- Kenichiro Onuma
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan
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- Yonmin Yan
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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- Tatsuya Nishioka
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan
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- Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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- Ikuko Yano
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan
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- Takayuki Miyara
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan
説明
<jats:p>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.</jats:p>
収録刊行物
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- Antibiotics
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Antibiotics 10 (1), 64-, 2021-01-11
MDPI AG