Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jun:5:57-61.
doi: 10.1016/j.jgar.2015.12.002. Epub 2015 Dec 21.

Clinical epidemiology of vancomycin-resistant Enterococcus gallinarum and Enterococcus casseliflavus bloodstream infections

Nicholas S Britt  1 , Emily M Potter  2
Affiliations

Clinical epidemiology of vancomycin-resistant Enterococcus gallinarum and Enterococcus casseliflavus bloodstream infections

Nicholas S Britt et al. J Glob Antimicrob Resist. 2016 Jun.

Abstract

This study aimed to evaluate the clinical outcomes of vancomycin-resistant enterococcal bloodstream infections (VRE BSI) caused by Enterococcus gallinarum or Enterococcus casseliflavus. Variables associated with treatment failure were determined and treatment options were compared. This was a national retrospective study of hospitalised Veterans Affairs patients with non-faecium, non-faecalis VRE BSI. The primary outcome was treatment failure, defined as a composite of: (i) 30-day all-cause mortality; (ii) microbiological failure; and (iii) 30-day VRE BSI recurrence. Stepwise Poisson regression was conducted to determine variables associated with treatment failure. In total, 48 patients were included, with 29 cases (60.4%) caused by E. gallinarum and 19 cases (39.6%) caused by E. casseliflavus. Among these cases, 20 (41.7%) were treated with an anti-VRE agent (linezolid or daptomycin) and 28 (58.3%) were treated with an anti-enterococcal β-lactam. Overall, 30-day mortality was 10.4% (5/48) and composite treatment failure was 39.6% (19/48). In multivariate analysis, treatment with an anti-enterococcal β-lactam was associated with increased treatment failure in comparison with anti-VRE therapy (adjusted risk ratio = 1.73, 95% confidence interval 1.06-4.97; P = 0.031). Overall, treatment with linezolid or daptomycin for vancomycin-resistant E. gallinarum or E. casseliflavus BSI resulted in improved clinical outcomes in comparison with anti-enterococcal β-lactam treatment.

Keywords: Bloodstream infection; Daptomycin; Linezolid; Vancomycin-resistant enterococci.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39:309–17. - PubMed
    1. Ramsey AM, Zilberberg MD. Secular trends of hospitalization with vancomycin-resistant Enterococcus infection in the United States, 2000–2006. Infect Control Hosp Epidemiol. 2009;30:184–6. - PubMed
    1. Watanabe S, Kobayashi N, Quinones D, Hayakawa S, Nagashima S, Uehara N, et al. Genetic diversity of the low-level vancomycin resistance gene vanC-2/vanC-3 and identification of a novel vanC subtype (vanC-4) in Enterococcus casseliflavus. Microb Drug Resist. 2009;15:1–9. - PubMed
    1. Lodise TP, McKinnon PS, Tam VH, Rybak MJ. Clinical outcomes for patients with bacteremia caused by vancomycin-resistant Enterococcus in a level 1 trauma center. Clin Infect Dis. 2002;34:922–9. - PubMed
    1. Koganemaru H, Hitomi S. Bacteremia caused by VanC-type enterococci in a university hospital in Japan: a 6-year survey. J Infect Chemother. 2008;14:413–7. - PubMed