Enterococcal bacteraemia ‘silent but deadly’: a population‐based cohort study

Abstract

Background: The high mortality rate of patients with enterococcal infections has been shown to be associated with the severity of underlying comorbidities.Aims: To characterise the epidemiology, clinical characteristics, outcomes and predictors of mortality in patients with enterococcal bacteraemia. Methods:This was a retrospective cohort study of all enterococcal bacteraemia episodes in the Barwon region between January 2010 and March 2017. We assessed the epidemiology, clinical characteristics, outcomes and predictors of mortality using descriptive statistics and simple and multiple logistic regression analyses.Results: The incidence of enterococcal bacteraemia was 19.9/100 000 person-years.Males comprised 68.4%, and the median age was 71 years. Common comorbidities were gastrointestinal tract disease, urological disease, malignancies and cardiovascular disease. Infective endocarditis was observed in 15% of patients, and 1 of 27 also had colorectal cancer. Twelve patients referred for colonoscopy demonstrated previously undiagnosed colorectal neoplasia in 75% of these cases. The 30-day and 1-year mortality rates were 11.7 and 40.2% respectively. Sixty-nine cases with vancomycin-resistant Enterococcus were observed. Multiple logistic regression suggested that the presence of underlying urological malignancy (adjusted odds ratio = 3.57, 95% confidence intervals = 1.10-11.65, P = 0.035) and colorectal cancer (adjusted odds ratio = 4.47, 95% confidence intervals = 1.36-14.66, P = 0.014) were significant predictors of 1-year mortality.Conclusions: Microbiological cure was inversely associated with 30-day mortality. The presence of underlying urological and colorectal malignancy was a predictor of 1-year mortality. We identified the importance of evaluating patients with Enterococcus faecalis bacteraemia for underlying colorectal neoplasia. Routine colonoscopy is recommended in patients with E. faecalis bacteraemia or infective endocarditis with an unclear source of infection. AbstractBackground: Activity-based funding (ABF) is a means of healthcare reimbursement, where hospitals are allocated funding based on the number and mix of clinical activity. The ABF model is based solely on Australian refined diagnosis-related group (AR-DRG) classifications of hospital encounters. Each AR-DRG is allocated a weighted activity unit (WAU) translating to cost value to determine ongoing funding allocations for each hospital annually.Aim: We explored cost consequences of AR-DRG coding variances within our Medical Oncology department over a 6-month period.Methods: All inpatient encounters for medical oncology from 1 January to 30 June 2014 were identified and paired with actual AR-DRG coding sheets submitted by the hospital coders. Inpatient charts were manually reviewed by a Medical Oncology Registrar to capture any changes or additional AR-DRGs, which were subsequently evaluated for total WAU value variance. Applying 1 WAU = $4676 as per the 2014 Queensland model, cost consequences were calculated.

Urinary tract infection caused by enterococcus spp: risk factors and mortality.

“…Moreover, we detected that urinary cancer was associated with bacteremia in patients with UTIs. In a recent study, urological cancer was also associated with bacteremia (20). These results support that regardless of E. faecalis-and E. faeciumcolonizing urinary tract infections, it is difficult for these pathogens to cross the urinary epithelium when innate immunity is preserved, but when it exists, rupture of the epithelial barrier can result in bacteremia.…”

“…Our results are consistent with other findings, and we showed that neutropenia, solid organ transplant, bone medullary transplant, and immunosuppression were also risk factors for bacteremia in patients with tract urinary infection caused by Enterococcus spp. (16,20). These are the same classic risk factors in patients with bacteremia, regardless of other origins (4).…”

Urinary tract infection caused by Enterococcus spp.: Risk factors and mortality. An observational study

“…Among the different comorbidities demonstrated by the patients, the most important were urinary disorders or severe systemic diseases. Among urological diseases, urological cancer has been described as a risk factor for Enterococcus UTIs (19,20). It is possible, as is the case in bacteremia associated with colorectal cancer (20), that lesions due to urinary epithelial colonization can be one of the most important predictive risk for urinary infections caused by Enterococcus.…”

Management of enterococcal central line-associated bloodstream infections in patients with cancer

“…Enterococcus species are generally considered to be of low virulence, so the previously reported association of enterococcal infections with higher mortality and a poor prognosis could be due to the association of these infections with malignancy and [“other”?] chronic comorbid conditions [ 16 , 17 ]. In our current study, harboring an isolate displaying vancomycin resistance was associated with higher infection-related and all-cause mortality, attributed by multivariate analysis to isolation of E. faecium and hospitalization in a critical-care setting.…”