This study assesses the clinical relevance of vancomycin-susceptible enterococci in bacteremic patients and compares it with bacteremia due to Staphylococcus aureus and Escherichia coli.
During a 5-year-study interval, clinical and diagnostic features of patients with enterococcal bacteremia were compared to those of patients with E. coli or S. aureus bacteremia. Each patient was only counted once per hospital stay.
During the 5-year study interval, data from 267 patients with enterococcal bacteremia and from 661 patients with bacteremia due to E. coli or S. aureus were evaluated. In spite of a comparable risk of death, patients with enterococci more frequently needed catecholamines and invasive ventilation. Furthermore, enterococci were more frequently associated with a mixed bacterial flora in bloodstream infections. While fatal sepsis due to E. coli and S. aureus was associated with typical shock symptoms, this association was not confirmed for enterococci.
Although enterococcal bacteremia is associated with a risk of dying comparable to that with bacteremia due to E. coli and S. aureus, a lower pathogenic potential of enterococci in bloodstream has to be acknowledged. Enterococci in the bloodstream are more likely to be an epiphenomenon of impending death than its major cause.
Ronald A : The etiology of urinary tract infection: traditional and emerging pathogens. Dis Mon 49, 71–82 (2003)
Megran DW : Enterococcal endocarditis. Clin Infect Dis 15, 63–71 (1992)
Bayer AS , Seidel JS, Yoshikawa TT, Anthony BF, Guze LB: Group D enterococcal meningitis. Clinical and therapeutic considerations with report of three cases and review of the literature. Arch Intern Med 136, 883–886 (1976)
Tornero E , Senneville E, Euba G, Petersdorf S, Rodriguez-Pardo D, Lakatos B, Ferrari MC, Pilares M, Bahamonde A, Trebse R, Benito N, Sorli L, del Toro MD, Baraiaetxaburu JM, Ramos A, Riera M, Jover-Sáenz A, Palomino J, Ariza J, Soriano A; European Society Group of Infections on Artificial Implants (ESGIAI): Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study. Clin Microbiol Infect 20, 1219–1224 (2014)
Mittelkötter U : Antimicrobial prophylaxis for abdominal surgery: is there a need for metronidazole? J Chemother 1, 27–34 (2001)
Solomkin JS , Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O’Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG: Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 50, 133–164 (2010)
Epstein EZ , Kugel MA: The significance of postmortem bacteriological examination: With special reference to streptococci and enterococci. J Infect Dis 44, 327–334 (1929)
McBride SJ , Upton A, Roberts SA: Clinical characteristics and outcomes of patients with vancomycin-susceptible Enterococcus faecalis and Enterococcus faecium bacteraemia – a five-year retrospective review. Eur J Clin Microbiol Infect Dis 29, 107–114 (2010)
Vydra J , Shanley RM, George I, Ustun C, Smith AR, Weisdorf DJ, Young JA: Enterococcal bacteraemia is associated with increased risk of mortality in recipients of allogeneic hematopoietic stem cell transplantation. Clin Infect Dis 55, 764–770 (2012)
Pinholt M , Ostergaard C, Arpi M, Bruun NE, Schønheyder HC, Gradel KO, Søgaard M, Knudsen JD; Danish Collaborative Bacteraemia Network (DACOBAN): Incidence, clinical characteristics and 30-day mortality of enterococcal bacteraemia in Denmark 2006–2009: a populationbased cohort study. Clin Microbiol Infect 20, 145–151 (2014)
Kajihara T , Nakamura S, Iwanaga N, Oshima K, Takazono T, Miyazaki T, Izumikawa K, Yanagihara K, Kohno N, Kohno S: Clinical characteristics and risk factors of enterococcal infections in Nagasaki, Japan: a retrospective study. BMC Infect Dis 15, 426 (2015)
Glauser MP , Zanetti G, Baumgartner JD, Cohen J: Septic shock: pathogenesis. Lancet 338, 732–736 (1991)
Laupland KB , Church DL: Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin Microbiol Rev 27, 647–664 (2014)
Lewis WH : The evolution of clinical sphygmomanometry. Bull N Y Acad Med 17, 871–881 (1941)
Top J , Willems R, Blok H, de Regt M, Jalink K, Troelstra A, Goorhuis B, Bonten M: Ecological replacement of Enterococcus faecalis by multiresistant clonal complex 17 Enterococcus faecium. Clin Microbiol Infect 13, 316–319 (2007)
Weisser M , Capaul S, Dangel M, Elzi L, Kuenzli E, Frei R, Widmer A: Additive effect of Enterococcus faecium on enterococcal bloodstream infections: a 14-year study in a Swiss tertiary hospital. Infect Control Hosp Epidemiol 34, 1109–1112 (2013)
Coombs GW , Pearson JC, Daley DA, Le T, Robinson OJ, Gottlieb T, Howden BP, Johnson PD, Bennett CM, Stinear TP, Turnidge JD; Australian Group on Antimicrobial Resistance: Molecular epidemiology of enterococcal bacteremia in Australia. J Clin Microbiol 52, 897–905 (2014)
Gastmeier P , Geffers C, Herrmann M, Lemmen S, Salzberger B, Seifert H, Kern W, Fätkenheuer G: Nosocomial infections and infections with multidrug-resistant pathogens – frequency and mortality. Dtsch Med Wochenschr 141, 421–426 (2016)
Rajkumari N , Mathur P, Thanbuana B, Sajan S, Misra MC: Magnitude of enterococcal bacteraemia in trauma patients admitted for intensive trauma care: a tertiary care experience from South Asian country. J Lab Physicians 7, 38–42 (2015)
Claeys KC , Zasowski EJ, Lagnf AM, Rybak MJ: Comparison of outcomes between patients with single versus multiple positive blood cultures for Enterococcus: infection versus illusion? Am J Infect Control 44, 47–49 (2016)
Gawryszewska I , Żabicka D, Bojarska K, Malinowska K, Hryniewicz W, Sadowy E: Invasive enterococcal infections in Poland: the current epidemiological situation. Eur J Clin Microbiol Infect Dis 35, 847–856 (2016)
Moses V , Jerobin J, Nair A, Sathyendara S, Balaji V, George IA, Peter JV: Enterococcal bacteraemia is associated with prolonged stay in the medical intensive care unit. J Glob Infect Dis 4, 26–30 (2012)
DiazGranados CA , Zimmer SM, Klein M, Jernigan JA: Comparison of mortality associated with vancomycinresistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 41, 327–333 (2005)
Prematunge C , MacDougall C, Johnstone J, Adomako K, Lam F, Robertson J, Garber G. VRE and VSE bacteraemia outcomes in the era of effective VRE therapy: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 37, 26–35 (2016)
Hayakawa K , Marchaim D, Palla M, Gudur UM, Pulluru H, Bathina P, Alshabani K, Govindavarjhulla A, Mallad A, Abbadi DR, Chowdary D, Kakarlapudi H, Guddati H, Das M, Kannekanti N, Vemuri P, Doddamani R, Mundra VR, Guddeti RR, Policherla R, Bai S, Lohithaswa S, Shashidharan SP, Chidurala S, Diviti S, Sukayogula K, Joseph M, Pogue JM, Lephart PR, Martin ET, Rybak MJ, Kaye KS: Epidemiology of vancomycin-resistant Enterococcus faecalis: a case-case-control study. Antimicrob Agents Chemother 57, 49–55 (2013)
Lu CL , Chuang YC, Chang HC, Chen YC, Wang JT, Chang SC: Microbiological and clinical characteristics of vancomycin- resistant Enterococcus faecium bacteraemia in Taiwan: implication of sequence type for prognosis. J Antimicrob Chemother 67, 2243–2249 (2012)
Conde-Estévez D , Grau S, Albanell J, Terradas R, Salvadó M, Knobel H: Clinical characteristics and outcomes of patients with vancomycin-susceptible Enterococcus faecalis and Enterococcus faecium bacteraemia in cancer patients. Eur J Clin Microbiol Infect Dis 30, 103–108 (2011)
Gudiol C , Ayats J, Camoez M, Domínguez MÁ, García-Vidal C, Bodro M, Ardanuy C, Obed M, Arnan M, Antonio M, Carratalà J: Increase in bloodstream infection due to vancomycin-susceptible Enterococcus faecium in cancer patients: risk factors, molecular epidemiology and outcomes. PLoS One 2013; 8:e74734 (2013)
Taur Y , Xavier JB, Lipuma L, Ubeda C, Goldberg J, Gobourne A, Lee YJ, Dubin KA, Socci ND, Viale A, Perales MA, Jenq RR, van den Brink MR, Pamer EG: Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clin Infect Dis 55, 905–914 (2012)
Freeman JT , Chen LF, Sexton DJ, Anderson DJ: Blood culture contamination with Enterococci and skin organisms: implications for surveillance definitions of primary bloodstream infections. Am J Infect Control 39, 436–438 (2011)
Jindai K , Strerath MS, Hess T, Safdar N: Is a single positive blood culture for Enterococcus species representative of infection or contamination? Eur J Clin Microbiol Infect Dis 33, 1995–2003 (2014)
Reuben AG , Musher DM, Hamill RJ, Broucke I: Polymicrobial bacteraemia: clinical and microbiologic patterns. Rev Infect Dis 11, 161–183 (1989)