Ou Tao-Hung, Yang Jia-Ling, Lin Chi-Ying, Huang Sung-Hsi, Chuang Yu-Chung, Wang Jann-Tay, Chen Yee-Chun, Chang Shan-Chwen
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
J Antimicrob Chemother. 2025 Sep 3;80(9):2408-2416. doi: 10.1093/jac/dkaf225.
The aim of this study is to evaluate the benefit of early appropriate antibiotics in vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs) amid increasing incidence and limited evidence supporting empirical VRE-active therapy.
We performed a cohort study (2010-23) involving patients with VRE BSI who received empiric Gram-positive coverage. Patients who did not receive VRE-active therapy (daptomycin or linezolid) were excluded. Based on their initial regimen, patients were classified into an empiric anti-VRE group or a glycopeptide (vancomycin or teicoplanin) group. The primary outcome was 28-day mortality.
We included 134 patients: 46 in the empiric anti-VRE group and 88 in the glycopeptide group. The 28-day mortality rate was 53.7%. All glycopeptide recipients switched to daptomycin, and 29 of the 46 (63%) patients in the empiric anti-VRE group also received daptomycin. Time to VRE-active therapy was shorter in the empiric anti-VRE group (0 versus 2 days; P < 0.001), and each day's delay correlated with higher mortality (0 day: 37.0%, 1 day: 57.7%, ≥2 days: 64.5%; P = 0.02). The empiric anti-VRE group had a lower 28-day mortality rate (37.0% versus 62.5%, P = 0.006). Multivariable analysis adjusting for comorbidities, steroid use, infection focus and bacteraemia severity indicated that empiric anti-VRE therapy was independently associated with lower mortality (adjusted OR 0.41; 95% CI, 0.17-0.98; P = 0.046).
Among patients with VRE BSI requiring empiric Gram-positive coverage, anti-VRE therapy was associated with reduced 28-day mortality compared with glycopeptides, even both groups eventually received VRE-active antibiotics. This highlights the critical role of timely, appropriate antibiotic to improve VRE BSI outcomes.
在耐万古霉素肠球菌（VRE）血流感染（BSIs）发病率不断上升且支持经验性VRE活性治疗的证据有限的情况下，本研究旨在评估早期使用合适抗生素的益处。
我们进行了一项队列研究（2010 - 2023年），纳入了接受经验性革兰氏阳性菌覆盖治疗的VRE BSI患者。未接受VRE活性治疗（达托霉素或利奈唑胺）的患者被排除。根据初始治疗方案，患者被分为经验性抗VRE组或糖肽类（万古霉素或替考拉宁）组。主要结局是28天死亡率。
我们纳入了134例患者：经验性抗VRE组46例，糖肽类组88例。28天死亡率为53.7%。所有接受糖肽类治疗的患者均改用达托霉素，经验性抗VRE组46例患者中有29例（63%）也接受了达托霉素治疗。经验性抗VRE组开始VRE活性治疗的时间更短（0天对2天；P<0.001），延迟一天与更高的死亡率相关（0天：37.0%，1天：57.7%，≥2天：64.5%；P = 0.02）。经验性抗VRE组的28天死亡率较低（37.0%对62.5%，P = 0.006）。对合并症、类固醇使用、感染部位和菌血症严重程度进行多变量分析表明，经验性抗VRE治疗与较低的死亡率独立相关（调整后的OR为0.41；95%CI，0.17 - 0.98；P = 0.046）。
在需要经验性革兰氏阳性菌覆盖治疗的VRE BSI患者中，与糖肽类药物相比，抗VRE治疗与28天死亡率降低相关，即使两组最终都接受了VRE活性抗生素治疗。这突出了及时、合适的抗生素在改善VRE BSI结局中的关键作用。
