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The incidence of bacteremia caused by  Enterococcus faecium , which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of  E. faecium  infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiological, and clinical characteristics using a Cox regression model and univariate analysis. We performed a multivariate analysis to identify risk factors for patients treated between 2014 and 2018. Among 186 patients with enterococcal bacteremia, two groups included in the Kaplan–Meier analysis ( E. faecalis  (n = 88) and  E. faecium  (n = 94)) showed poor overall survival in the  E. faecium  group (HR: 1.92; 95% confidence interval: 1.01–3.66;  p  = 0.048). The median daily antibiotic cost per patient in the  E. faecium  group was significantly higher than that in the  E. faecalis  group ($23 ($13–$34) vs. $34 ($22–$58),  p  < 0.001).  E. faecium  strains were more frequently identified with previous use of antipseudomonal penicillins (OR = 4.04,  p  < 0.001) and carbapenems (OR = 3.33,  p  = 0.003). Bacteremia from an unknown source (OR = 2.79,  p  = 0.025) and acute kidney injury (OR = 4.51,  p  = 0.004) were associated with higher risks of 30-day mortality in patients with enterococcal bacteremia. Therefore, clinicians should provide improved medical management, with support from specialized teams such as those assisting antimicrobial stewardship programs.

antibiotics

Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital