576. A Multicenter Epidemiology Study on Risk Factors of Vancomycin-Resistant Enterococcus Infections in China: Results from the China Antimicrobial Surveillance Network (CHINET) in 2016

Abstract

Background. Bacterial resistance in China had been increasing in prevalence. Vancomycin-resistant enterococcus (VRE) different from other bacteria had lower isolated rate and apparent regional variations. In this study, we identified the characteristics of VRE infections in Chinese patients based on the China Antimicrobial Surveillance Network (CHINET) in 2016. Methods. This case-control study was conducted in 97 VRE patients and 95 Vancomycin-susceptible Enterococcus (VSE) patients from 20 medical centers. Demographics, disease characteristics, therapeutic measure, as well as laboratory data were obtained from medical records for analysis. Descriptive statistics, simple and multivariate logistic regression were performed to explore the risk factors of VRE infection. Results. The mean age of patients in the case and control groups was 75.0 years and 65.0 years, respectively. In the case group, 52 patients developed urinary tract infections, accounting for 53.6%, followed by bloodstream infections (19.6%) and abdominal infections (5.2%). And the cases of Enterococcus faecium, Enterococcus faecalis and other enterococci infections were 70 (72.2%), 7 (7.2%), and 20 (20.6%), respectively. Moreover, the proportion of vancomycin usage before infection was 20.6%. The result of resistance analysis showed VRE patients' other dug resistance rate was higher than VSE ones. Compared with VSE patients, VRE patients had received more urinary intubation, indwelling venous catheter, and dialysis. Additionally, the proportions of combination with stroke (8.3% vs. 2.1%), multiple organ failure (8.3% vs. 3.2%), and other infection (59.8% vs. 40.0%) were higher in the case group. What's more, 44 (45.4%) VRE patients had been treated in intensive care unit, while 21 (22.1%) cases in the control group. Multivariate logistic regression showed that receiving indwelling venous catheter was independent risk factor for VRE infection (OR=3.342, 95% CI: 1.379∼8.099). For prognosis, VRE patients had a lower effective rate (67.4% vs. 83.7%), higher hospital expense (¥94991 vs. ¥38248), and longer hospital stay (26.0 days vs. 21.0 days). Conclusion. Indwelling venous catheter may increase the VRE infection risk and Linezolid or Fosfomycin could still be used for infection treatment in VRE patients. (Table Presented).