575. Evaluation of Risk Factors and Clinical Outcomes of Patients with Vancomycin-Resistant Enterococcus Infections

Abstract

Introduction: Vancomycin-resistant Enterococci (VRE) occurs with enhanced frequency in hospitalized patients and is usually associated with poor clinical outcomes. Research Question or Hypothesis: What are the risk factors and clinical outcomes of patients with VRE infections? Study Design: This was an IRB approved multi-center retrospective chart review conducted at a three-hospital health system between August 2016-November 2018. Inclusion criteria were patients ≥18 years and admitted for ≥24 hours with cultures positive for VRE. Patients pregnant or colonized with VRE were excluded. Methods: The primary endpoint analyzed the association of potential risk factors with all-cause in-hospital mortality (ACM) and 30-day readmission; subgroup analysis focused on the association of risk factors with VRE bacteremia. The secondary endpoint evaluated the impact of different treatment groups of high-dose daptomycin (HDD) vs. low-dose daptomycin (LDD) vs. linezolid (LZD) on ACM and 30-day readmission; subgroup analysis focused on difference of length of stay (LOS), length of therapy (LOT), duration of bacteremia (DOB) and clinical success (CS) between the treatment groups. Results: Final analysis included 81 patients; overall mortality was observed at 16%. Utilizing multivariate logistic regression analyses, patients presenting from long-term care facilities (LTCF) were found to have increased risk for mortality. No specific risk factors were associated with 30-day readmission. Patients with previous exposure to fluoroquinolones (FQ) and cephalosporins (CPS), nosocomial exposure and history of heart failure (HF) showed association with VRE bacteremia. ACM was similar between HDD vs. LDD vs. LZD (16.7% vs. 15.4% vs. 0%, P = 0.52). No differences were seen between LOS, LOT, CS, and DOB between the groups. Conclusion: Admission from LTCFs was a risk factor associated with in-hospital mortality in VRE patients. Individuals with history of FQ, CPS and nosocomial exposure as well as history of HF showed increased risk of acquiring VRE bacteremia. There were no differences in ACM, LOS, LOT, and DOB between HDD, LDD & LZD.