BACKGROUNDPrior data suggest that vancomycin-resistant Enterococcus (VRE) bacteremia is associated with worse outcomes than vancomycin-sensitive Enterococcus (VSE) bacteremia. However, many studies evaluating such outcomes were conducted prior to the availability of effective VRE therapies.OBJECTIVETo systematically review VRE and VSE bacteremia outcomes among hospital patients in the era of effective VRE therapy.METHODSElectronic databases and grey literature published between January 1997 and December 2014 were searched to identify all primary research studies comparing outcomes of VRE and VSE bacteremias among hospital patients, following the availability of effective VRE therapies. The primary outcome was all-cause, in-hospital mortality, while total hospital length of stay (LOS) was a secondary outcome. All meta-analyses were conducted in Review Manager 5.3 using random-effects, inverse variance modeling.RESULTSAmong all the studies reviewed, 12 cohort studies and 1 case control study met inclusion criteria. Similar study designs were combined in meta-analyses for mortality and LOS. VRE bacteremia was associated with increased mortality compared with VSE bacteremia among cohort studies (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.38–2.35; I2=0%; n=11); the case-control study estimate was similar, but not significant (OR, 1.93; 95% CI, 0.97–3.82). LOS was greater for VRE bacteremia patients than for VSE bacteremia patients (mean difference, 5.01 days; 95% CI, 0.58–9.44]; I2=0%; n=5).CONCLUSIONSDespite the availability of effective VRE therapy, VRE bacteremia remains associated with an increased risk of in-hospital mortality and LOS when compared to VSE bacteremia.Infect. Control Hosp. Epidemiol. 2015;37(1):26–35

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Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the ICU are at highest risk of VRE bacteremia, particularly at large hospitals and teaching hospitals.

BackgroundImported malaria is the principal, preventable, life-threatening infection among Canadians travelling abroad. The Canadian Malaria Network supplies information and parenteral malaria therapy to healthcare providers treating severe and complicated malaria and gathers surveillance information on these cases.MethodsData were collected on the characteristics, risk factors, and clinical outcomes of severe malaria cases in Canada from June 2001 to December 2013.ResultsThe need for parenteral therapy in Canada has increased in the last decade. The vast majority of cases are reported from Ontario and Quebec and occur among travellers to and from Africa. Regardless of country of birth, all persons originating from endemic and non-endemic countries are at a similar risk of malaria-related complications. Overall use and appropriateness of pre-travel advice and chemoprophylaxis remains low. Most cases result from patient delays in recognizing symptoms and seeking appropriate medical attention. Although some healthcare delays occurred in a select number of cases, the majority of patients were diagnosed quickly and were appropriately treated with parenteral therapy within a few hours of diagnosis.ConclusionsData from the Canadian Malaria Network provide insight into the characteristics of imported severe and complicated malaria infections in Canada. Improved understanding of this population can help target risk reduction strategies and interventions to limit personal susceptibility and healthcare treatment delays.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0638-y) contains supplementary material, which is available to authorized users.

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