Contemporary Clinical and Molecular Epidemiology of Vancomycin-Resistant Enterococcal Bacteremia: A Prospective Multicenter Cohort Study (VENOUS I)

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dc.contributor.authorContreras, Germán
dc.contributor.authorMunita, José
dc.contributor.authorSimar, Shelby
dc.contributor.authorLuterbach, Courtney
dc.contributor.authorDinh, An Q.
dc.contributor.authorRydell, Kirsten
dc.contributor.authorSahasrabhojane, Pranoti
dc.contributor.authorRios, Rafael
dc.contributor.authorDíaz, Lorena
dc.contributor.authorReyes, Katherine
dc.contributor.authorZervos, Marcus
dc.contributor.authorMisikir, Helina
dc.contributor.authorSánchez, Gabriela
dc.contributor.authorLiu, Catherine
dc.contributor.authorDoi, Yohei
dc.contributor.authorAbbo, Lilian
dc.contributor.authorShimose, Luis
dc.contributor.authorSeifert, Harald
dc.contributor.authorGudiol, Carlota
dc.contributor.authorBarberis, Fernanda
dc.contributor.authorPedroza, Claudia
dc.contributor.authorAitken, Samuel
dc.contributor.authorShelburne, Samuel
dc.contributor.authorDuin, David
dc.contributor.authorTran, Truc
dc.contributor.authorHanson, Blake
dc.contributor.authorArias, Cesar
dc.date.accessioned2022-03-29T16:05:27Z
dc.date.available2022-03-29T16:05:27Z
dc.date.issued2021
dc.description.abstractBackground: 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.es
dc.description.versionVersión publicadaes
dc.identifier.citationContreras GA, Munita JM, Simar S, Luterbach C, Dinh AQ, Rydell K, Sahasrabhojane PV, Rios R, Diaz L, Reyes K, Zervos M, Misikir HM, Sanchez-Petitto G, Liu C, Doi Y, Abbo LM, Shimose L, Seifert H, Gudiol C, Barberis F, Pedroza C, Aitken SL, Shelburne SA, van Duin D, Tran TT, Hanson BM, Arias CA. Contemporary Clinical and Molecular Epidemiology of Vancomycin-Resistant Enterococcal Bacteremia: A Prospective Multicenter Cohort Study (VENOUS I). Open Forum Infect Dis. 2021 Dec 23;9(3):ofab616. doi: 10.1093/ofid/ofab616es
dc.identifier.urihttps://doi.org/10.1093/ofid/ofab616es
dc.identifier.urihttp://hdl.handle.net/11447/5845
dc.language.isoenes
dc.subjectEnterococcuses
dc.subjectVREes
dc.subjectBacteremiaes
dc.titleContemporary Clinical and Molecular Epidemiology of Vancomycin-Resistant Enterococcal Bacteremia: A Prospective Multicenter Cohort Study (VENOUS I)es
dc.typeArticlees
dcterms.sourceOpen forum infectious diseaseses

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