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Vancomycin-resistant enterococci bacteremia: risk factors for mortality and influence of antimicrobial therapy on clinical outcome

Authors
 Sang Hoon Han  ;  Bum Sik Chin  ;  Han Sung Lee  ;  Su Jin Jeong  ;  Hee Kyoung Choi  ;  Chang Oh Kim  ;  Dongeun Yong  ;  Jun Yong Choi  ;  Young Goo Song  ;  Kyungwon Lee  ;  June Myung Kim 
Citation
 JOURNAL OF INFECTION, Vol.58(3) : 182-190, 2009 
Journal Title
JOURNAL OF INFECTION
ISSN
 0163-4453 
Issue Date
2009
MeSH
APACHE ; Adult ; Aged ; Anti-Bacterial Agents/therapeutic use* ; Bacteremia/drug therapy* ; Bacteremia/microbiology* ; Bacteremia/mortality ; Enterococcus/drug effects* ; Enterococcus/isolation & purification ; Female ; Gram-Positive Bacterial Infections/drug therapy* ; Gram-Positive Bacterial Infections/microbiology* ; Gram-Positive Bacterial Infections/mortality ; Humans ; Male ; Middle Aged ; Risk Factors ; Shock, Septic ; Time Factors ; Treatment Outcome ; Vancomycin Resistance*
Keywords
Vancomycin-resistant enterococci ; Bacteremia ; Mortality
Abstract
OBJECTIVES: This study evaluated the effects of antimicrobial treatment against vancomycin-resistant enterococci (VRE) and delayed administration of anti-VRE therapy on mortality, and determined independent risk factors for delayed all-cause mortality of VRE bacteremia patients.

METHODS: Over 10 years, 153 patients with clinically significant monomicrobial VRE bacteremia were identified among a total of 2834 patients in a VRE cohort. The main outcomes were immediate (7-day) and delayed (28-day, 60-day) all-cause mortality.

RESULTS: The 7-day (P<0.001) and 28-day (P=0.041) mortalities were lower in the group receiving anti-VRE therapy, but the 60-day mortality (P=0.113) was unaffected. The mortalities of patients receiving anti-VRE therapy later than 72h after the onset of bacteremia were no different from that of patients receiving treatment within 72h. Both a higher APACHE II score (hazard ratio [HR], 1.10; P<0.001 and HR, 1.12; P<0.001, respectively) and the presence of septic shock at the onset of bacteremia (HR, 1.91; P=0.047 and HR, 1.78; P=0.034, respectively) were independent risk factors for 28-day and 60-day mortality.

CONCLUSION: These findings suggest that in spite of antibiotic therapy against VRE, patients with VRE bacteremia eventually have a higher risk of death because of severe illness at the onset of bacteremia.
Full Text
http://www.sciencedirect.com/science/article/pii/S016344530900036X
DOI
10.1016/j.jinf.2009.01.013
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Kim, June Myung(김준명)
Kim, Chang Oh(김창오) ORCID logo https://orcid.org/0000-0002-0773-5443
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Yong, Dong Eun(용동은) ORCID logo https://orcid.org/0000-0002-1225-8477
Lee, Kyungwon(이경원) ORCID logo https://orcid.org/0000-0003-3788-2134
Lee, Han Sung(이한성)
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Chin, Bum Sik(진범식)
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
Choi, Hee Kyoung(최희경)
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/103550
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