P-1087. Predictors of Mortality and Outcomes in Patients with Infections Due to Vancomycin-Resistant Enterococcus faecium

TL;DR

This study identifies factors that increase mortality risk in patients with vancomycin-resistant Enterococcus faecium infections and shows that proper antibiotic treatment reduces death risk.

Contribution

The study identifies new independent predictors of mortality in VRE infections and emphasizes the importance of antibiogram-guided therapy.

Findings

Prior renal replacement therapy, hematologic malignancy, and septic shock at diagnosis are associated with higher mortality in VRE infections.

Appropriate therapy guided by antibiograms significantly reduces the risk of death in these patients.

Abstract

Infections due to vancomycin-resistant Enterococcus faecium (VRE) represent major therapeutic challenges and carry a high mortality. Limited rapid diagnostic platforms and therapeutic options exist. Early identification of mortality predictors could guide appropriate timely treatment. We aimed to identify the factors associated with 90-day all-cause mortality in patients with VRE infections.

We conducted a retrospective cohort study that included all admitted patients with VRE infections from January 1, 2013, to December 31, 2023. Patients were follow-up for 90 days. The primary outcome was 90-day all-cause mortality after VRE diagnosis. Secondary outcomes included length of stay, mechanical ventilation, ICU admission, renal replacement therapy (RRT), and infection relapse during follow-up. Bivariate and multivariate Cox-proportional hazards models were constructed to identify factors independently associated with 90-day all-cause mortality.

A total of 184 patients were included. Death occurred in 65 (35%) cases. The most frequent infection site was intraabdominal (84, 45%). Frequent comorbidities were immunosuppression (106, 58%), arterial hypertension (45, 25%), hematologic malignancy (40, 22%) and diabetes mellitus (39, 21%). Appropriate therapy was administered in 145 (79%) cases. The median length of stay in survivors was 42 days (IQR 28-65). Mechanical ventilation, ICU admission, and RRT during follow-up occurred in 8/144 (6%), 12/143 (8%) and 7/162 (4%), respectively. Infection relapse occurred in 19/184 (10%) cases.

In the multivariate analysis, prior RRT (aHR 2.33, 95%CI 1.06-5.14), hematologic malignancy (aHR 3.46, 95%CI 1.60-7.50), and septic shock at diagnosis (aHR 5.37, 95%CI 2.99-9.66) were associated with all-cause death. Antibiogram-guided appropriate therapy was associated with a lower risk of death (aHR 0.30, 95%CI 0.16-0.55).

Renal replacement therapy, hematologic malignancy, and septic shock are associated with worse prognosis. Antibiogram-guided appropriate therapy is associated with a lower risk of death. Recognition of the prognostic factors could assist in improving patient care. Therapeutic options must be widely available and promptly prescribed when necessary.

All Authors: No reported disclosures