TY - JOUR
T1 - Epidemiology, Management, and Risk-Adjusted Mortality of ICU-Acquired Enterococcal Bacteremia
AU - Ong, David S. Y.
AU - Bonten, Marc J. M.
AU - Safdari, Khatera
AU - Spitoni, Cristian
AU - Frencken, Jos F.
AU - Witteveen, Esther
AU - Horn, Janneke
AU - Klein Klouwenberg, Peter M. C.
AU - Cremer, Olaf L.
AU - AUTHOR GROUP
AU - de Beer, Friso M.
AU - Bos, Lieuwe D. J.
AU - van Hooijdonk, Roosmarijn T. M.
AU - Huson, Mischa A.
AU - Schouten, Laura R. A.
AU - Straat, Marleen
AU - van Vught, Lonneke A.
AU - Wiewel, Maryse A.
AU - Glas, Gerie J.
AU - Wieske, Luuk
AU - Schultz, Marcus J.
AU - van der Poll, Tom
PY - 2015
Y1 - 2015
N2 - Enterococcal bacteremia has been associated with high case fatality, but it remains unknown to what extent death is caused by these infections. We therefore quantified attributable mortality of intensive care unit (ICU)-acquired bacteremia caused by enterococci. From 2011 to 2013 we studied consecutive patients who stayed >48 hours in 2 tertiary ICUs in the Netherlands, using competing risk survival regression and marginal structural modeling to estimate ICU mortality caused by enterococcal bacteremia. Among 3080 admissions, 266 events of ICU-acquired bacteremia occurred in 218 (7.1%) patients, of which 76 were caused by enterococci (incidence rate, 3.0 per 1000 patient-days at risk; 95% confidence interval [CI], 2.3-3.7). A catheter-related bloodstream infection (CRBSI) was suspected in 44 (58%) of these, prompting removal of 68% of indwelling catheters and initiation of antibiotic treatment for a median duration of 3 (interquartile range 1-7) days. Enterococcal bacteremia was independently associated with an increased case fatality rate (adjusted subdistribution hazard ratio [SHR], 2.68; 95% CI, 1.44-4.98). However, for patients with CRBSI, case fatality was similar for infections caused by enterococci and coagulase-negative staphylococci (CoNS; adjusted SHR, 0.91; 95% CI, .50-1.67). Population-attributable fraction of mortality was 4.9% (95% CI, 2.9%-6.9%) by day 90, reflecting a population-attributable risk of 0.8% (95% CI, .4%-1.1%). ICU-acquired enterococcal bacteremia is associated with increased case fatality; however, the mortality attributable to these infections is low from a population perspective. The virulence of enterococci and CoNS in a setting of CRBSI seems comparable
AB - Enterococcal bacteremia has been associated with high case fatality, but it remains unknown to what extent death is caused by these infections. We therefore quantified attributable mortality of intensive care unit (ICU)-acquired bacteremia caused by enterococci. From 2011 to 2013 we studied consecutive patients who stayed >48 hours in 2 tertiary ICUs in the Netherlands, using competing risk survival regression and marginal structural modeling to estimate ICU mortality caused by enterococcal bacteremia. Among 3080 admissions, 266 events of ICU-acquired bacteremia occurred in 218 (7.1%) patients, of which 76 were caused by enterococci (incidence rate, 3.0 per 1000 patient-days at risk; 95% confidence interval [CI], 2.3-3.7). A catheter-related bloodstream infection (CRBSI) was suspected in 44 (58%) of these, prompting removal of 68% of indwelling catheters and initiation of antibiotic treatment for a median duration of 3 (interquartile range 1-7) days. Enterococcal bacteremia was independently associated with an increased case fatality rate (adjusted subdistribution hazard ratio [SHR], 2.68; 95% CI, 1.44-4.98). However, for patients with CRBSI, case fatality was similar for infections caused by enterococci and coagulase-negative staphylococci (CoNS; adjusted SHR, 0.91; 95% CI, .50-1.67). Population-attributable fraction of mortality was 4.9% (95% CI, 2.9%-6.9%) by day 90, reflecting a population-attributable risk of 0.8% (95% CI, .4%-1.1%). ICU-acquired enterococcal bacteremia is associated with increased case fatality; however, the mortality attributable to these infections is low from a population perspective. The virulence of enterococci and CoNS in a setting of CRBSI seems comparable
U2 - https://doi.org/10.1093/cid/civ560
DO - https://doi.org/10.1093/cid/civ560
M3 - Article
C2 - 26179013
SN - 1058-4838
VL - 61
SP - 1413
EP - 1420
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 9
ER -