Del Monte M, Kaleci S, Chester J, Zerbato V, Remitti M, Tili A, Dessilani A, Baldisserotto I, Esperti S, Di Trapani M D, Orlando G, Casolari S, Catania A, Bedini A, Franceschini E, Sarti M, Venturelli C, Venturelli I, Rofrano L, Ricchizzi E, Di Bella S, Mussini C, Meschiari M
Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.
J Antimicrob Chemother. 2025 Sep 3;80(9):2466-2473. doi: 10.1093/jac/dkaf242.
Conflicting results exist about mortality risk of infections caused by vancomycin-susceptible Enterococcus faecium (VSEfm) and vancomycin-resistant Enterococcus faecium (VREfm). Our aim was to compare risk factors and clinical outcomes among patients with VSEfm and VREfm bloodstream infections (BSIs).
A retrospective, multicentre, cohort study enrolled consecutive adult patients with VSEfm and VREfm BSI diagnosis between 2018-2022. Primary outcomes were 30-day-attributable and 30-day-overall mortality. Multivariable analysis propensity-weighted adjusted for timing to active therapy, Pitt Bacteremia Score (PBS) and Charlson Comorbidity Index (CCI) were performed to identify variables independently associated with 30-day mortality.
Overall, 446 patients were enrolled: 140 (31.4%) VREfm and 306 (68.6%) VSEfm. Comparatively, VREfm patients more frequently received inappropriate antibiotic therapy, had higher sequential organ failure assessment, PBS and BSI relapses. 30-day-attributable and 30-day-overall mortality did not differ significantly between the two groups. Independent risk factors for 30-day attributable mortality were age (HR 1.04, CI95%, 1.00-1.08, P = 0.022), corticosteroid therapy (HR 3.05, CI95%, 1.24-7.47, P = 0.014) and septic shock (HR 9.10, CI95%, 3.80-21.79, P≤0.001), and overall mortality were age (HR 1.04, CI95%, 1.02-1.05, P≤0.001.), chronic liver failure (HR 1.67, CI95%, 1.02-2.75, P = 0.04) and haematological disease (HR 2.25, CI95%, 1.28-3.94, P = 0.005). Vancomycin resistance is not an independent risk factor for mortality when data are adjusted for confounding factors.
Adjusted analyses for time to active antibiotic therapy suggest that vancomycin resistance is not an independent risk factor for overall or attributable mortality among patients with Enterococcus faecium BSI. Independent risk factors identified in this study were exclusively comorbidities, severity and corticosteroids use.
关于万古霉素敏感粪肠球菌（VSEfm）和万古霉素耐药粪肠球菌（VREfm）引起的感染的死亡风险，存在相互矛盾的结果。我们的目的是比较VSEfm和VREfm血流感染（BSI）患者的危险因素和临床结局。
一项回顾性、多中心队列研究纳入了2018年至2022年间连续诊断为VSEfm和VREfm BSI的成年患者。主要结局是30天归因死亡率和30天总体死亡率。进行多变量分析，对开始积极治疗的时间、皮特菌血症评分（PBS）和查尔森合并症指数（CCI）进行倾向加权调整，以确定与30天死亡率独立相关的变量。
总体而言，共纳入446例患者：140例（31.4%）为VREfm，306例（68.6%）为VSEfm。相比之下，VREfm患者更频繁地接受不适当的抗生素治疗，序贯器官衰竭评估、PBS和BSI复发率更高。两组之间的30天归因死亡率和30天总体死亡率没有显著差异。30天归因死亡率的独立危险因素是年龄（HR 1.04，CI95%，1.00-1.08，P = 0.022）、皮质类固醇治疗（HR 3.05，CI95%，1.24-7.47，P = 0.014）和感染性休克（HR 9.10，CI95%，3.80-21.79，P≤0.001），总体死亡率的独立危险因素是年龄（HR 1.04，CI95%，1.02-1.05，P≤0.001）、慢性肝衰竭（HR 1.67，CI95%，1.02-2.75，P = 0.04）和血液系统疾病（HR 2.25，CI95%，1.28-3.94，P = 0.005）。当对数据进行混杂因素调整后，万古霉素耐药不是死亡的独立危险因素。
对开始积极抗生素治疗时间的调整分析表明，万古霉素耐药不是粪肠球菌BSI患者总体或归因死亡率的独立危险因素。本研究确定的独立危险因素仅为合并症、严重程度和皮质类固醇的使用。
