Browsing by Author "Contreras, Germán"
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Item Contemporary Clinical and Molecular Epidemiology of Vancomycin-Resistant Enterococcal Bacteremia: A Prospective Multicenter Cohort Study (VENOUS I)(2021) Contreras, Germán; Munita, José; Simar, Shelby; Luterbach, Courtney; Dinh, An Q.; Rydell, Kirsten; Sahasrabhojane, Pranoti; Rios, Rafael; Díaz, Lorena; Reyes, Katherine; Zervos, Marcus; Misikir, Helina; Sánchez, Gabriela; Liu, Catherine; Doi, Yohei; Abbo, Lilian; Shimose, Luis; Seifert, Harald; Gudiol, Carlota; Barberis, Fernanda; Pedroza, Claudia; Aitken, Samuel; Shelburne, Samuel; Duin, David; Tran, Truc; Hanson, Blake; Arias, CesarBackground: Vancomycin-resistant enterococci (VRE) are major therapeutic challenges. Prospective contemporary data characterizing the clinical and molecular epidemiology of VRE bloodstream infections (BSIs) are lacking. Methods: The Vancomycin-Resistant Enterococcal BSI Outcomes Study (VENOUS I) is a prospective observational cohort of adult patients with enterococcal BSI in 11 US hospitals. We included patients with Enterococcus faecalis or Enterococcus faecium BSI with ≥1 follow-up blood culture(s) within 7 days and availability of isolate(s) for further characterization. The primary study outcome was in-hospital mortality. Secondary outcomes were mortality at days 4, 7, 10, 12, and 15 after index blood culture. A desirability of outcome ranking was constructed to assess the association of vancomycin resistance with outcomes. All index isolates were subjected to whole genome sequencing. Results: Forty-two of 232 (18%) patients died in hospital and 39 (17%) exhibited microbiological failure (lack of clearance in the first 4 days). Neutropenia (hazard ratio [HR], 3.13), microbiological failure (HR, 2.4), VRE BSI (HR, 2.13), use of urinary catheter (HR, 1.85), and Pitt BSI score ≥2 (HR, 1.83) were significant predictors of in-hospital mortality. Microbiological failure was the strongest predictor of in-hospital mortality in patients with E faecium bacteremia (HR, 5.03). The impact of vancomycin resistance on mortality in our cohort changed throughout the course of hospitalization. Enterococcus faecalis sequence type 6 was a predominant multidrug-resistant lineage, whereas a heterogeneous genomic population of E faecium was identified. Conclusions: Failure of early eradication of VRE from the bloodstream is a major factor associated with poor outcomes.