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July 8, 1996

Bloodstream Infections With Vancomycin-Resistant Enterococci

Author Affiliations

From the Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla (Drs Montecalvo, Patel, Tacsa, and Wormser); and the Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Shay, Maloney, and Jarvis). Dr Shay is now with the University of Washington Medical Center, Seattle; Dr Patel, Kaiser Permanente, Irving, Tex; Dr Tacsa, Jersey City (NJ) Medical Center; and Dr Maloney, Children's National Medical Center, Washington, DC.

Arch Intern Med. 1996;156(13):1458-1462. doi:10.1001/archinte.1996.00440120120013

Objectives:  To describe the population in whom bloodstream infections with vancomycin-resistant enterococci occur and the clinical and microbiologic features of infection.

Methods:  From June 1, 1991, to January 31, 1994, 73 patients with bloodstream infections with vancomycin-resistant enterococci were identified by retrospective review of hospital charts and microbiology records.

Results:  Fifty-two (73%) of 71 patients with evaluable data were hospitalized in an intensive care unit, the adult oncology unit, or the acquired immunodeficiency syndrome unit. Before the development of the bloodstream infection with vancomycin-resistant enterococci, patients were hospitalized and received antibiotics for a median of 26 and 25.5 days, respectively. A hematologic malignancy, respiratory failure, or renal failure requiring dialysis was present in 59 patients (83%). Acute Physiology and Chronic Health Evaluation II scores of the patients ranged from 6 to 35 (median, 17). Forty-five (63%) of the patients died. Compared with 37 patients who had only a single positive blood culture, the 34 patients with 2 or more blood cultures positive for vancomycin-resistant enterococci more often were neutropenic or had acquired immunodeficiency syndrome (74% vs 35%; P=.002).

Conclusions:  Bloodstream infections with vancomycin-resistant enterococci predominantly affect severely ill patients who have received extensive antibiotic treatment during a prolonged hospitalization. Immunocompromised patients are more likely to have a persistent bloodstream infection with vancomycin-resistant enterococci.Arch Intern Med. 1996;156:1458-1462