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Bloodstream infections with vancomycin-resistant enterococci are associated with a decreased survival in patients with hematological diseases

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Abstract

Enterococcus species are commensals of the human gastrointestinal tract with the ability to cause invasive infections. For patients with hematological diseases, enterococcal bloodstream infections (BSI) constitute a serious clinical complication which may even be aggravated if the pathogen is vancomycin-resistant. Therefore, we analyzed the course of BSI due to vancomycin-susceptible enterococci (VSE) in comparison to vancomycin-resistant enterococci (VRE) on patient survival. In this retrospective single-center study, BSI were caused by VRE in 47 patients and by VSE in 43 patients. Baseline patient characteristics were similar in both groups. Concerning infection-related characteristics, an increased CRP value and an increased rate of prior colonization with multidrug-resistant organisms were detected in the VRE BSI group. More enterococcal invasive infections were found in the VSE group. The primary endpoint, overall survival (OS) at 30 days after BSI, was significantly lower in patients with VRE BSI compared to patients with VSE BSI (74.5% vs. 90.7%, p = 0.039). In a multivariate regression analysis, VRE BSI and a Charlson comorbidity index higher than 4 were independent factors associated with 30-day mortality. Moreover, we found that VRE with an additional teicoplanin resistance showed a trend towards an even lower OS.

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Acknowledgments

The authors thank all the physicians, nurses, technicians, and other hospital staff involved in patient care and lab work.

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Authors and Affiliations

  1. Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany

    Sarah Weber, Sebastian Wolf, Hubert Serve, Björn Steffen & Sebastian Scheich

  2. University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany

    Sarah Weber, Michael Hogardt, Claudia Reinheimer, Thomas A. Wichelhaus, Volkhard A. J. Kempf, Johanna Kessel, Sebastian Wolf, Hubert Serve, Björn Steffen & Sebastian Scheich

  3. Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany

    Michael Hogardt, Claudia Reinheimer, Thomas A. Wichelhaus & Volkhard A. J. Kempf

  4. University Center of Competence for Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany

    Michael Hogardt, Claudia Reinheimer, Thomas A. Wichelhaus & Volkhard A. J. Kempf

  5. Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt am Main, Germany

    Johanna Kessel

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Weber, S., Hogardt, M., Reinheimer, C. et al. Bloodstream infections with vancomycin-resistant enterococci are associated with a decreased survival in patients with hematological diseases. Ann Hematol 98, 763–773 (2019). https://doi.org/10.1007/s00277-019-03607-z

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