Emergence of vancomycin-resistant Enterococcus bloodstream infections in southern Taiwan

Background: An increased incidence of vancomycin-resistant enterococcal bloodstream infections (VRE BSI) in the United States has been noted in recent years. There were a few reports of VRE BSI in Taiwan. This study is intended to show the epidemiology, clinical features and outcomes of VRE BSI at a medical center in southern Taiwan. Methods: A retrospective study was conducted from January 1, 2005 to December 31, 2010. All patients with VRE BSI episodes were identified and their medical records were reviewed. Results: A total of 69 episodes of VRE BSI were identified in the study period. The incidence rate increased from 0.01 episodes of VRE BSI/1000 patient-days in 2005 to 0.07 episodes of VRE BSI/1000 patient-days in 2010. The 30-day mortality rate was 52.17% for all patients with VRE BSI. The mortality rate of patients who received . in vitro active and inactive antimicrobial therapy for VRE BSI was 40% and 100%, respectively (. p < 0.001). Factors associated with mortality were shock [odds ratio (OR) 24.4, 95% confidence interval (CI) 3.6-163.2, . p = . 0.001], renal failure (OR 90.9, 95% CI 1.9-4404.3, . p = 0.02), and underlying liver cirrhosis (OR 12.4, 95% CI 1.2-125.8, . p = 0.03). Use of linezolid for VRE BSI showed a trend for lower 30-day mortality than daptomycin therapy (35.5% . vs. 56.3%, . p = 0.17). Conclusion: VRE BSI is increasingly important in the study hospital and is associated with a significant mortality rate. Appropriateness of antimicrobial therapy has a prognostic impact on patients with VRE BSI.