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Volume 45, Number 3, June 2012

Emergence of vancomycin-resistant Enterococcus bloodstream infections in southern Taiwan


Chien-Hsuan Chou, Nan-Yao Lee, Hsin-Chun Lee, Chia-Ming Chang, Ching-Chi Lee, Wen-Chien Ko


Received: April 30, 2011    Revised: July 22, 2011    Accepted: August 2, 2011   

 

Corresponding author:

Department of Internal Medicine, National Cheng Kung University Hospital, Number 138, Sheng Li Road, Tainan 704, Taiwan. E-mail address: winston@mail.ncku.edu.tw (W.-C. Ko).



 

Background and purpose: 

 An 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 



 

Methods:

 A 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. 

 


 

Results:

 Results: A 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) 3.6e163.2, p Z 0.001], renal failure (OR 90.9, 95% CI 1.9e4404.3, p Z 0.02), and underlying liver cirrhosis (OR 12.4, 95% CI 1.2e125.8, p Z 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 Z 0.17).



 

Conclusion:

VRE 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.



 

Key words:

Bacteremia; Daptomycin; Linezolid; Vancomycin-resistant Enterococcus