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J Infect Dis. 2005 Feb 15;191(4):588-95. Epub 2005 Jan 17.

Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection.

Author information

1
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia 30333, USA.

Abstract

We performed a retrospective cohort study to measure the impact of vancomycin resistance on clinical outcome for 83 episodes of enterococcal bloodstream infection (BSI; 22 with vancomycin-resistant enterococci [VRE] and 61 with vancomycin-susceptible enterococci [VSE]) in 77 patients with neutropenia. Cox proportional hazards models showed that vancomycin resistance was an independent predictor of mortality, after controlling for severity of illness, enterococcal species, gram-negative copathogens, sex, race, duration of neutropenia before bacteremia, and early administration of active antibiotics. This effect was evident only > or =10 days after the onset of bacteremia (P=.0263; hazard ratio [HR], 4.969) but not after adjustment for duration of bacteremia. The median duration of bacteremia was 4.5 days for VRE BSI and <1 day for VSE BSI (P=.0001). The only independent predictor of bacteremia duration was vancomycin resistance (P=.0284; HR, 3.863). Vancomycin resistance is associated with increased mortality in patients with neutropenia, possibly because of prolonged duration of bacteremia.

PMID:
15655783
DOI:
10.1086/427512
[Indexed for MEDLINE]

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