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Article

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

1
Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan
2
Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan
3
Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan
4
Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
5
Division of Advanced Medical Science, Kobe University Graduate School of Science, Technology and Innovation, Kobe 657-8501, Japan
6
Department of Medical Technology, Kobe Tokiwa University, Kobe 653-0838, Japan
7
Department of Clinical Laboratory, Kobe University Hospital, Kobe 650-0017, Japan
*
Author to whom correspondence should be addressed.
Received: 12 December 2020 / Revised: 3 January 2021 / Accepted: 7 January 2021 / Published: 11 January 2021
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 1st Volume)
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. View Full-Text
Keywords: enterococcal; bacteremia; epidemiology; risk factors; mortality; antimicrobial stewardship enterococcal; bacteremia; epidemiology; risk factors; mortality; antimicrobial stewardship
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MDPI and ACS Style

Uda, A.; Shigemura, K.; Kitagawa, K.; Osawa, K.; Onuma, K.; Yan, Y.; Nishioka, T.; Fujisawa, M.; Yano, I.; Miyara, T. 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. Antibiotics 2021, 10, 64. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010064

AMA Style

Uda A, Shigemura K, Kitagawa K, Osawa K, Onuma K, Yan Y, Nishioka T, Fujisawa M, Yano I, Miyara T. 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. Antibiotics. 2021; 10(1):64. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010064

Chicago/Turabian Style

Uda, Atsushi, Katsumi Shigemura, Koichi Kitagawa, Kayo Osawa, Kenichiro Onuma, Yonmin Yan, Tatsuya Nishioka, Masato Fujisawa, Ikuko Yano, and Takayuki Miyara. 2021. "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" Antibiotics 10, no. 1: 64. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010064

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