A retrospective observational study on enterococcal bacteraemia and endocarditis at a regional hospital in New South Wales, Australia.

BACKGROUND

Enterococcal infection poses a major clinical problem due to increasing antibiotic resistance and rising numbers of health care related infections. It is also associated with high morbidity and mortality. The aim of this study is to examine demographic characteristics, co-morbidities and clinical outcomes of the patients as well as susceptibility spectrum of all Enterococcal bacteraemia and endocarditis.

METHODS

A retrospective observational study was performed on cases of Enterococcal bacteraemia and endocarditis at Port Macquarie Base Hospital, New South Wales, Australia from 1st January 2012 till 31st December 2018.

RESULTS

Out of 75 patients with Enterococcal bacteraemia, about 70% were male. E.faecalis was responsible for about two-thirds of bacteraemia. E.faecalis most commonly presented as infective endocarditis whereas intraabdominal infection was the most common presentation for E.faecium. 90-day all-cause mortality for all Enterococcal bacteraemia was 29.3% (22 out of 75) with a higher mortality rate with E.faecium bacteraemia in comparison to E.faecalis bacteraemia (47.8% Vs 20.8%). Vancomycin resistance was noted only in 17.4% of E.faecium species. There were 18 patients with infective endocarditis over 7 years period with a yearly prevalence rate of 2.6%. Readmission was 78% and mortality was 16.7% within 90 days of admission. Regarding the use of echocardiogram, about 41.3% of Enterococcal bacteraemia did not have echocardiograms.

CONCLUSION

Enterococcal bacteraemia was associated with high morbidity and mortality, particularly secondary to E.faecium bacteraemia. Enterococcal IE was associated with high rates of complications, readmissions, and prolonged inpatient stay.