Clinical characteristics, predisposing factors and outcomes for Enterococcus faecalis versus Enterococcus faecium bloodstream infections: a prospective multicentre cohort study

Eur J Clin Microbiol Infect Dis. 2024 Oct;43(10):2011-2022. doi: 10.1007/s10096-024-04917-5. Epub 2024 Aug 8.

Abstract

Purposes: Enterococcal BSI is associated with significant morbidity and mortality, with fatality rates of approximately 20-30%. There are microbiological and clinical differences between E. faecalis and E. faecium infections. The aim of this study was to investigate differences in predisposing factors for E. faecalis and E. faecium BSI and to explore prognostic factors.

Methods: This study was a post-hoc analysis of PROBAC, a Spanish prospective, multicenter, cohort in 2016-2017. Patients with E. faecalis or E. faecium BSI were eligible. Independent predictors for BSI development in polymicrobial and monomicrobial BSI and in-hospital mortality in the monomicrobial group were identified by logistic regression.

Results: A total of 431 patients were included. Independent factors associated with E. faecium BSI were previous use of penicillins (aOR 1.99 (95% CI 1.20-3.32)) or carbapenems (2.35 (1.12-4.93)), hospital-acquired BSI (2.58 (1.61-4.12)), and biliary tract source (3.36 (1.84-6.13)), while congestive heart failure (0.51 (0.27-0.97)), cerebrovascular disease (0.45 (0.21-0.98)), and urinary tract source (0.49 (0.26-0.92)) were associated with E. faecalis BSI. Independent prognostic factors for in-hospital mortality in E. faecalis BSI were Charlson Comorbidity Index (1.27 (1.08-1.51)), SOFA score (1.47 (1.24-1.73)), age (1.06 (1.02-1.10)), and urinary/biliary source (0.29 (0.09-0.90)). For E. faecium BSI, only SOFA score (1.34 (1.14-1.58) was associated with in-hospital mortality.

Conclusions: The factors associated with E. faecium and E. faecalis BSI are different. These variables may be helpful in the suspicion of one or other species for empiric therapeutic decisions and provide valuable information on prognosis.

Keywords: Enterococcus faecalis; Enterococcus faecium; Bloodstream infection; Mortality; Prognostic factors.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia* / epidemiology
  • Bacteremia* / microbiology
  • Bacteremia* / mortality
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Cross Infection / mortality
  • Enterococcus faecalis* / isolation & purification
  • Enterococcus faecium* / drug effects
  • Enterococcus faecium* / isolation & purification
  • Female
  • Gram-Positive Bacterial Infections* / epidemiology
  • Gram-Positive Bacterial Infections* / microbiology
  • Gram-Positive Bacterial Infections* / mortality
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Spain / epidemiology

Substances

  • Anti-Bacterial Agents