Morbidity and Mortality Comparing Vancomycin-Sensitive E. faecium and Vancomycin-Resistant E. faeciu

BACKGROUND: Enterococcus, the fourth leading nosocomial pathogen in U.S. hospitals, is responsible for >13% of such infections. vancomycin-resistant Enterococcus faecium (VRE) accounts for 26% of all enterococcal nosocomial infections and is almost exclusively E. faecium. METHODS: This 1-year retrospective study conducted at two community hospitals examined differences between VRE and vancomycin-sensitive Enterococcus faecium (VSE) nosocomial infections. All patients having culture-proven infections with E. faecium were included if the infection occurred 48 hours or longer after admission. RESULTS: The 25 VSE infections were distributed as follows: urinary tract infection (UTI)—48%; skin and soft tissue infection (SSI)—32%; bloodstream infection (BSI)—12%; and respiratory infection (RI)—8%. The 26 VRE infections were distributed as follows: UTI—38.5%; SSI—42%; BSI—15.5%; and RI—0%. There was no statistically significant difference in length of stay among the types of infected patients in the two groups except SSI: VSE= 26.3 days versus VRE= 62.9 days (p= 0.0049). There was no statistically significant difference in mortality among the types of infected patients in the two groups except for BI: VSE= 33% versus VRE= 100% (p= 0.0229). CONCLUSIONS: Although UTIs were the leading nosocomial infections in both groups, morbidity, as reflected in length of stay, was much greater in patients with VRE SSIs than in patients with VSE SSIs. Patients acquiring VRE BSIs all had a fatal outcome. This study demonstrated a difference in virulence for VSE versus VRE, but only in patients acquiring SSIs and BSIs.