Predictors of mortality of enterococcal bacteraemia and the role of source control interventions; a retrospective cohort study.

PURPOSE

To identify predictors of mortality among patients with enterococcal bacteraemia.

METHODS

This retrospective study was conducted at the Lausanne University Hospital, Switzerland and included adult patients with enterococcal bacteraemia from 2014 to 2023.

RESULTS

During the study period, 768 enterococcal bacteraemia episodes were included. The predominant species was Enterococcus faecalis (427 episodes; 56%). Sepsis or septic shock were present in 351 (46%) episodes. The overall 30-day mortality rate was 19% (148 episodes). The Cox multivariable regression model showed that age > 60 years (aHR: 1.75, 95% CI: 1.05-2.90), nosocomial infection (1.78, 1.19-2.65), sepsis or septic shock (3.67, 2.48-5.45), and not performing source control interventions within 48 h, in patients on or discussing of transitioning to limitations of care (5.91, 3.13-11.14) were associated with 30-day mortality. Conversely, infectious diseases (ID) consultation within 48 h (0.40, 0.28-0.57), appropriate antimicrobial therapy within 48 h (0.54, 0.34-0.86), and source control interventions performed within 48 h (0.22, 0.14-0.36) or not warranted (0.54; 0.34-0.86) were associated with survival. Among the 737 episodes without limitation of care, the Cox multivariable regression model showed that nosocomial infection (1.78, 1.19-2.67), sepsis or septic shock (3.76, 2.42-5.82), were associated with 30-day mortality. Conversely, ID consultation within 48 h (0.44, 0.30-0.65), appropriate antimicrobial therapy within 48 h (0.51, 0.30-0.86), and source control interventions performed within 48 h (0.25, 0.16-0.40) or not warranted (0.40; 0.26-0.61) were associated with survival.

CONCLUSIONS

Our findings underscore the pivotal role of early management of enterococcal bacteraemia, including ID consultation, appropriate antimicrobial treatment initiation and performance of source control interventions.