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Multicenter Study
. 2025 Jul;13(7):e0005225.
doi: 10.1128/spectrum.00052-25. Epub 2025 Jun 5.

Risk factors for vancomycin resistance in patients with Enterococcus faecium bloodstream infections: an analysis of the Munich Multicentric Enterococci Cohort

Laura Wagner  1   2 , Milena Wurst  1 , Johanna Erber  1   2 , Tobias Bachfischer  1 , Bernhard Haller  3 , Sabine Gleich  4 , Karl Dichtl  5   6 , Roland M Schmid  1   2 , Julian Triebelhorn  1   2 , Florian Voit  1   2 , Ulrich Seybold  2   7 , Dirk H Busch  2   8 , Patrick C Rämer  9 , Christoph D Spinner  1   2 , Jochen Schneider  1   2 , Kathrin Rothe  8
Affiliations
Multicenter Study

Risk factors for vancomycin resistance in patients with Enterococcus faecium bloodstream infections: an analysis of the Munich Multicentric Enterococci Cohort

Laura Wagner et al. Microbiol Spectr. 2025 Jul.

Abstract

Enterococcus faecium is difficult to treat owing to its intrinsic and acquired resistance to antibiotics, particularly vancomycin. Vancomycin-resistant Enterococcus faecium is an important cause of bloodstream infections in healthcare settings with limited treatment options. This study aimed to analyze the risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection. This retrospective analysis of data from the Munich Multicentric Enterococci Cohort analyzed 200 episodes of nonrecurrent vancomycin-susceptible Enterococcus faecium bloodstream infection and 196 episodes of nonrecurrent vancomycin-resistant Enterococcus faecium bloodstream infection from six hospitals in Munich, Germany, between 2010 and 2019. Logistic regression was used to identify risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection. In the unadjusted analysis, the risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection included the length of hospital stay, previous treatment with vancomycin or linezolid, and solid organ transplantation. In the multivariable analysis, prior treatment with vancomycin and solid organ transplantation were independent risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection. Vancomycin resistance was not significantly associated with the severity of underlying diseases. This study identified prior vancomycin treatment and solid organ transplantation as key independent risk factors for vancomycin-resistant Enterococcus faecium bloodstream infection.

Importance: Vancomycin-resistant Enterococcus faecium is a growing threat in healthcare settings, challenging the management of enterococcal infections. This study identified prior treatment with vancomycin and solid organ transplantation as risk factors for vancomycin-resistant Enterococcus faecium bloodstream infections. Based on the analysis of five disease severity scores for acute and chronic illness, the severity of underlying diseases could not be demonstrated to be a risk factor for the occurrence of vancomycin resistance in Enterococcus faecium bloodstream infections.

Keywords: Enterococcus; Enterococcus faecium; antibiotic resistance; bloodstream infections; vancomycin resistance.

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Conflict of interest statement

J.E. received personal fees from Gilead Sciences and non-financial support from Gilead Sciences, Pfizer, Tillotts Pharma GmbH, and ViiV Healthcare. C.D.S. reports grants and personal fees from AbbVie; grants, fees, and non-financial support from Gilead Sciences; grants and personal fees from Janssen-Cilag; grants and personal fees from MSD; grants from Cepheid; personal fees from GSK; grants and personal fees from ViiV Healthcare; fees from AstraZeneca and other from Apeiron; grants, personal fees, and non-financial support from BBraun Melsungen; grants and personal fees from BioNtech; personal fees from Eli Lilly; personal fees from Formycon; personal fees from Moderna; personal fees from Molecular partners; personal fees from Novartis; grants and personal fees from Eli Lilly; personal fees from Roche; personal fees from SOBI; personal fees from Shionogi; personal fees from Pfizer; ant travel grants by Copan. All other authors received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Figures

Fig 1
Fig 1
Flow chart of study cohort selection. BSI, bloodstream infection; ECFA, Enterococcus faecalis; ECFM, Enterococcus faecium; LRE, linezolid-resistant Enterococcus faecium; LVRE, linezolid- and vancomycin-resistant Enterococcus faecium; VRE, vancomycin-resistant Enterococcus faecium. Adapted from (12).
Fig 2
Fig 2
Box and whisker plots of the disease severity scores in patients with vancomycin-resistant enterococcus (VRE) bloodstream infection (BSI) (blue boxes) and Enterococcus faecium (ECFM) BSI (green boxes). (A) Pitt Bacteremia Score (PBS); (B) Simplified Acute Physiology Score (SAPS); (C) Sequential Organ Failure Assessment (SOFA) score (D) Charlson Comorbidity Index (CCI); and (E) Acute Physiology and Chronic Health Evaluation (APACHE II).
Fig 3
Fig 3
Forest plot of risk factors for VRE BSI versus ECFM BSI in the unadjusted logistic regression analysis. BSI, bloodstream infection; CCI, Charlson Comorbidity Index; CI, confidence interval; ECFM, Enterococcus faecium; OR, odds ratio; PBS, Pitt Bacteremia Score; SOFA, Sequential Organ Failure Assessment; VRE, vancomycin-resistant Enterococcus faecium.
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