UNLABELLED

Enterococcal bloodstream infections (BSIs) in critically ill patients are linked to multidrug resistance (MDR), high morbidity, and increased mortality. We conducted a retrospective cohort study over a decade at a 3,500-bed teaching hospital, including intensive care unit patients diagnosed with enterococcal BSIs. Data on demographics, comorbidities, severity scores, treatments, and microbiological profiles were analyzed. Risk factors for infection and mortality were assessed using multivariate logistic regression. Among 101 patients, was the predominant species, with nearly half of these isolates exhibiting MDR, particularly to ampicillin, aminoglycosides, and fluoroquinolones. Primary infection sources among all patients included abdominal (58.4%), catheter-related (32.7%), and wound infections (10.9%). Key mortality risk factors included a high Charlson comorbidity index (CCI ≥ 5; hazard ratio [HR] = 18.18, < 0.001), male sex (HR = 3.09, = 0.0174), prolonged hospitalization, mechanical ventilation >7 days, central venous catheter (CVC) use, prior broad-spectrum antibiotic exposure, immunosuppression, and delayed antimicrobial therapy (>24 hours; HR = 11.11, < 0.001). Prior fluoroquinolone exposure and inadequate source control also increased mortality risk. In contrast, early source control (HR = 0.08, < 0.001), timely targeted therapy (HR = 0.09, = 0.00214), and early CVC removal (HR = 0.01, < 0.001) improved survival. Persistent bacteremia and inflammatory markers were not independent mortality predictors. Future research should optimize antibiotic duration, refine risk prediction models, and develop novel therapies for MDR infections.

IMPORTANCE

Enterococcal bloodstream infections are a serious concern in critically ill patients, often associated with multidrug resistance (MDR) and high mortality rates. This study highlights the importance of early intervention, including source control and timely antimicrobial therapy, in improving patient outcomes. By identifying key risk factors for mortality, such as comorbidities, male sex, and delayed treatment, this research provides valuable insights for clinicians in managing these infections. Notably, the study emphasizes the crucial role of early removal of central venous catheters and targeted therapy in reducing mortality risk. These findings underscore the need for effective infection prevention strategies and timely clinical decisions in critically ill patients. This work lays the foundation for future research aimed at optimizing treatment approaches and combating the growing challenge of MDR infections in intensive care settings.