Enterococcal bacteraemia

Factors influencing mortality, length of stay and costs of hospitalization

A. L. Y. Cheah, T. Spelman, D. Liew, Trisha Peel, B. P. Howden, D. Spelman, M. L. Grayson, R. L. Nation, D. C. M. Kong

Research output: Contribution to journalArticleResearchpeer-review

62 Citations (Scopus)

Abstract

Enterococci are a major cause of nosocomial bacteraemia. The impacts of vanB vancomycin resistance and antibiotic therapy on outcomes in enterococcal bacteraemia are unclear. Factors that affect length of stay (LOS) and costs of managing patients with enterococcal bacteraemia are also unknown. This study aimed to identify factors associated with mortality, LOS and hospitalization costs in patients with enterococcal bacteraemia and the impact of vancomycin resistance and antibiotic therapy on these outcomes. Data from 116 patients with vancomycin-resistant Enterococci (VRE), matched 1:1 with patients with vancomycin-susceptible Enterococcus (VSE), from two Australian hospitals were reviewed for clinical and economic outcomes. Univariable and multivariable logistic and quantile regression analyses identified factors associated with mortality, LOS and costs. Intensive care unit admission (OR, 8.57; 95 CI, 3.99-18.38), a higher burden of co-morbidities (OR, 4.55; 95 CI, 1.83-11.33) and longer time to appropriate antibiotics (OR, 1.02; 95 CI, 1.01-1.03) were significantly associated with mortality in enterococcal bacteraemia. VanB vancomycin resistance increased LOS (4.89 days; 95 CI, 0.56-11.52) and hospitalization costs (AU 28 872; 95 CI, 734-70 667), after adjustment for confounders. Notably, linezolid definitive therapy was associated with lower mortality (OR, 0.13; 95 CI, 0.03-0.58) in vanB VRE bacteraemia patients. In patients with VSE bacteraemia, time to appropriate antibiotics independently influenced mortality, LOS and hospitalization costs, and underlying co-morbidities were associated with mortality. The study findings highlight the importance of preventing VRE bacteraemia and the significance of time to appropriate antibiotics in the management of enterococcal bacteraemia.
Original languageEnglish
Pages (from-to)E181 - E189
Number of pages9
JournalClinical Microbiology and Infection
Volume19
Issue number4
DOIs
Publication statusPublished - Apr 2013

Keywords

  • Enterococci
  • bacteraemia
  • health outcomes
  • length of stay
  • mortality
  • cost

Cite this

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title = "Enterococcal bacteraemia: Factors influencing mortality, length of stay and costs of hospitalization",
abstract = "Enterococci are a major cause of nosocomial bacteraemia. The impacts of vanB vancomycin resistance and antibiotic therapy on outcomes in enterococcal bacteraemia are unclear. Factors that affect length of stay (LOS) and costs of managing patients with enterococcal bacteraemia are also unknown. This study aimed to identify factors associated with mortality, LOS and hospitalization costs in patients with enterococcal bacteraemia and the impact of vancomycin resistance and antibiotic therapy on these outcomes. Data from 116 patients with vancomycin-resistant Enterococci (VRE), matched 1:1 with patients with vancomycin-susceptible Enterococcus (VSE), from two Australian hospitals were reviewed for clinical and economic outcomes. Univariable and multivariable logistic and quantile regression analyses identified factors associated with mortality, LOS and costs. Intensive care unit admission (OR, 8.57; 95 CI, 3.99-18.38), a higher burden of co-morbidities (OR, 4.55; 95 CI, 1.83-11.33) and longer time to appropriate antibiotics (OR, 1.02; 95 CI, 1.01-1.03) were significantly associated with mortality in enterococcal bacteraemia. VanB vancomycin resistance increased LOS (4.89 days; 95 CI, 0.56-11.52) and hospitalization costs (AU 28 872; 95 CI, 734-70 667), after adjustment for confounders. Notably, linezolid definitive therapy was associated with lower mortality (OR, 0.13; 95 CI, 0.03-0.58) in vanB VRE bacteraemia patients. In patients with VSE bacteraemia, time to appropriate antibiotics independently influenced mortality, LOS and hospitalization costs, and underlying co-morbidities were associated with mortality. The study findings highlight the importance of preventing VRE bacteraemia and the significance of time to appropriate antibiotics in the management of enterococcal bacteraemia.",
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author = "Cheah, {A. L. Y.} and T. Spelman and D. Liew and Trisha Peel and Howden, {B. P.} and D. Spelman and Grayson, {M. L.} and Nation, {R. L.} and Kong, {D. C. M.}",
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Enterococcal bacteraemia : Factors influencing mortality, length of stay and costs of hospitalization. / Cheah, A. L. Y.; Spelman, T.; Liew, D.; Peel, Trisha; Howden, B. P.; Spelman, D.; Grayson, M. L.; Nation, R. L.; Kong, D. C. M.

In: Clinical Microbiology and Infection, Vol. 19, No. 4, 04.2013, p. E181 - E189.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Enterococcal bacteraemia

T2 - Factors influencing mortality, length of stay and costs of hospitalization

AU - Cheah, A. L. Y.

AU - Spelman, T.

AU - Liew, D.

AU - Peel, Trisha

AU - Howden, B. P.

AU - Spelman, D.

AU - Grayson, M. L.

AU - Nation, R. L.

AU - Kong, D. C. M.

PY - 2013/4

Y1 - 2013/4

N2 - Enterococci are a major cause of nosocomial bacteraemia. The impacts of vanB vancomycin resistance and antibiotic therapy on outcomes in enterococcal bacteraemia are unclear. Factors that affect length of stay (LOS) and costs of managing patients with enterococcal bacteraemia are also unknown. This study aimed to identify factors associated with mortality, LOS and hospitalization costs in patients with enterococcal bacteraemia and the impact of vancomycin resistance and antibiotic therapy on these outcomes. Data from 116 patients with vancomycin-resistant Enterococci (VRE), matched 1:1 with patients with vancomycin-susceptible Enterococcus (VSE), from two Australian hospitals were reviewed for clinical and economic outcomes. Univariable and multivariable logistic and quantile regression analyses identified factors associated with mortality, LOS and costs. Intensive care unit admission (OR, 8.57; 95 CI, 3.99-18.38), a higher burden of co-morbidities (OR, 4.55; 95 CI, 1.83-11.33) and longer time to appropriate antibiotics (OR, 1.02; 95 CI, 1.01-1.03) were significantly associated with mortality in enterococcal bacteraemia. VanB vancomycin resistance increased LOS (4.89 days; 95 CI, 0.56-11.52) and hospitalization costs (AU 28 872; 95 CI, 734-70 667), after adjustment for confounders. Notably, linezolid definitive therapy was associated with lower mortality (OR, 0.13; 95 CI, 0.03-0.58) in vanB VRE bacteraemia patients. In patients with VSE bacteraemia, time to appropriate antibiotics independently influenced mortality, LOS and hospitalization costs, and underlying co-morbidities were associated with mortality. The study findings highlight the importance of preventing VRE bacteraemia and the significance of time to appropriate antibiotics in the management of enterococcal bacteraemia.

AB - Enterococci are a major cause of nosocomial bacteraemia. The impacts of vanB vancomycin resistance and antibiotic therapy on outcomes in enterococcal bacteraemia are unclear. Factors that affect length of stay (LOS) and costs of managing patients with enterococcal bacteraemia are also unknown. This study aimed to identify factors associated with mortality, LOS and hospitalization costs in patients with enterococcal bacteraemia and the impact of vancomycin resistance and antibiotic therapy on these outcomes. Data from 116 patients with vancomycin-resistant Enterococci (VRE), matched 1:1 with patients with vancomycin-susceptible Enterococcus (VSE), from two Australian hospitals were reviewed for clinical and economic outcomes. Univariable and multivariable logistic and quantile regression analyses identified factors associated with mortality, LOS and costs. Intensive care unit admission (OR, 8.57; 95 CI, 3.99-18.38), a higher burden of co-morbidities (OR, 4.55; 95 CI, 1.83-11.33) and longer time to appropriate antibiotics (OR, 1.02; 95 CI, 1.01-1.03) were significantly associated with mortality in enterococcal bacteraemia. VanB vancomycin resistance increased LOS (4.89 days; 95 CI, 0.56-11.52) and hospitalization costs (AU 28 872; 95 CI, 734-70 667), after adjustment for confounders. Notably, linezolid definitive therapy was associated with lower mortality (OR, 0.13; 95 CI, 0.03-0.58) in vanB VRE bacteraemia patients. In patients with VSE bacteraemia, time to appropriate antibiotics independently influenced mortality, LOS and hospitalization costs, and underlying co-morbidities were associated with mortality. The study findings highlight the importance of preventing VRE bacteraemia and the significance of time to appropriate antibiotics in the management of enterococcal bacteraemia.

KW - Enterococci

KW - bacteraemia

KW - health outcomes

KW - length of stay

KW - mortality

KW - cost

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U2 - 10.1111/1469-0691.12132

DO - 10.1111/1469-0691.12132

M3 - Article

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SN - 1198-743X

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