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Enterococcus bacteraemia: striking high mortality

Abstract number: 1734_164

Suppli M., Aabenhus R., Harboe Z., Andersen L., Tvede M., Kirkby N., Jensen J.

Objective: To assess the character and degree of underlying disease in patients with enterococcal bacteraemia compared with E. coli bacteraemia. Additionally to determine if such differences can explain variations in mortality between the two bacteria.

Methods: All patients identified with E. faecium, E. faecalis or E. coli bacteraemia at Rigshopitalet, Copenhagen, were included in the study. Demographic, diagnostic and mortality data were compared for patients with Enterococcus and E. coli bacteraemia. Patients were excluded from mortality analyses if: (a) younger than 16 years, (b) suffering from haematologic cancer or (c) with an unregistered date of death. Statistical analyses were performed using Student's test and Mann–Whitney U-test to compare continuous variables and chi-squared test for equal proportions or Fisher's exact test to compare categorical variables.

Results: 326 patients with E. faecium and E. faecalis bacteraemia and 225 patients with E. coli bacteraemia were included in the study. Mortality at 90 days after the first positive bloodculture was 36.7% among Enterococcus bacteraemia patients, and 25.9% among E. coli patients (p = 0.03). There was no difference in mortality at 10 and 30 days, (p= 0.57 and 0.45 respectively). No differences in age were observed and median age were 60.5 and 60.0 years in the two groups (p = 0.54). Acute renal failure, respiratory insufficiency, peritonitis, congestive heart failure and endocarditis were more common in patient with Enterococcus bacteraemia (P < 0.05), while solid cancer were more common among E. coli patients (p = 0.057).

90-days morality

 DeadAliveMortality
Enterococcus7613136.7%
E. coli4512925.9%
P = 0.03 (Fischer). OR(Dead by Enterocococcus bacteraemia): 1.66 [1.07–2.59] (Woolf's approximation).

Conclusions: The observed differences in mortality between Enterococcus and E. coli at 90 days are unrelated to age and haematological malignancies. Also of interest is that solid cancers were more frequent in E. coli bacteraemia. Patients with Enterococcus bacteraemia had a higher frequency of congestive heart failure and endocarditis. The present findings suggest that Enterococcal bacteraemia is a strong independent predictor of death. Further investigations are needed to explore whether pathogenic processes in the heart are involved in the death of patients with Enterococcus bacteraemia, even when endocarditis is not diagnosed.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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