Open AccessImpact of vanA -Positive Enterococcus faecium Exhibiting Diverse Susceptibility Phenotypes to Glycopeptides on 30-Day Mortality of Patients with a Bloodstream Infection
Author(s) -
Do Kyun Kim,
Eunju Yoon,
Jun Hong,
Hyukmin Lee,
Kyeong Seob Shin,
Jeong Hwan Shin,
Young Ree Kim,
Hyun Soo Kim,
Young Ah Kim,
Young Uh,
Jong Hee Shin,
Yoon Soo Park,
Seok Hoon Jeong
Publication year - 2020
Publication title -
antimicrobial agents and chemotherapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.07
H-Index - 259
eISSN - 1070-6283
pISSN - 0066-4804
DOI - 10.1128/aac.02180-19
Subject(s) - enterococcus faecium , logistic regression , glycopeptide , observational study , bloodstream infection , medicine , bacteremia , enterococcus , biology , microbiology and biotechnology , antibiotics
This study was performed to evaluate the impacts of vanA positivity of Enterococcus faecium exhibiting diverse susceptibility phenotypes to glycopeptides on clinical outcomes in patients with a bloodstream infection (BSI) through a prospective, multicenter, observational study. A total of 509 patients with E. faecium BSI from eight sentinel hospitals in South Korea during a 2-year period were enrolled in this study. Risk factors of the hosts and causative E. faecium isolates were assessed to determine associations with the 30-day mortality of E. faecium BSI patients via multivariable logistic regression analyses. The vanA gene was detected in 35.2% (179/509) of E. faecium isolates; 131 E. faecium isolates exhibited typical VanA phenotypes (group vanA -VanA), while the remaining 48 E. faecium isolates exhibited atypical phenotypes (group vanA -atypical), which included VanD ( n = 43) and vancomycin-variable phenotypes ( n = 5). A multivariable logistic regression indicated that vanA positivity of causative pathogens was independently associated with the increased 30-day mortality rate in the patients with E. faecium BSI; however, there was no significant difference in survival rates between the patients of the vanA -VanA and vanA -atypical groups (log rank test, P = 0.904). A high 30-day mortality rate was observed in patients with vanA -positive E. faecium BSIs, and vanA positivity of causative E. faecium isolates was an independent risk factor for early mortality irrespective of the susceptibility phenotypes to glycopeptides; thus, intensified antimicrobial stewardship is needed to improve the clinical outcomes of patients with vanA -positive E. faecium BSI.