Clinical characteristics and outcomes of patients with vancomycin-susceptible Enterococcus faecalis and Enterococcus faecium bacteraemia—a five-year retrospective review

  • S. J. McBrideEmail author
  • A. Upton
  • S. A. Roberts


The purpose of this study was to assess the epidemiology and outcomes of enterococcal bacteraemia. A retrospective review of demographic, microbiological and clinical data in patients 16 years of age and over with Enterococcus faecalis or E. faecium bacteraemia at Auckland City Hospital, New Zealand, from June 2002 to May 2007 was carried out. A total of 212 patients fulfilled the inclusion criteria, with 205 being included in the analysis. E. faecalis accounted for 86% (176/205) and E. faecium 14% (29/205) of the patients. Amoxycillin resistance occurred in 69% (20/29) of E. faecium isolates. High-level gentamicin resistance was present in 38% (65/171) of E. faecalis isolates and 25% (7/28) of E. faecium isolates (P = NS). No vancomycin-resistant enterococci were isolated. Healthcare association was present in 73% (149/205) of patients. Co-morbidities were present in 86% (176/205) of patients. The 7-day mortality was 13% (27/205) and the 30-day mortality 25% (52/205). On multivariate analysis, the 7-day mortality was statistically significantly associated with cirrhosis and shorter intravenous amoxycillin therapy. The 30-day mortality was statistically significantly associated with cirrhosis, malignancy, E. faecium bacteraemia and not receiving active antimicrobial therapy. No statistically significant association between high-level gentamicin resistance and mortality was demonstrated on multivariate analysis. Enterococcal bacteraemia occurs in a co-morbid, healthcare-exposed population. Associated mortality is high, and is associated with severe underlying disease, E. faecium bacteraemia and treatment factors.


Amoxycillin Attributable Mortality Residential Care Facility Invasive Device Enterococcal Infection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors wish to acknowledge Graham McBride for his assistance with the statistical analysis, and the staff of the microbiology laboratory at LabPlus, the laboratory serving Auckland City Hospital (ACH), New Zealand.

Conflicts of interest

Stephen McBride: no conflicts of interest.

Arlo Upton: no conflicts of interest.

Sally Roberts: no conflicts of interest.

Funding received

No funding was received for this work.


  1. 1.
    Jett BD, Huycke MM, Gilmore MS (1994) Virulence of enterococci. Clin Microbiol Rev 7(4):462–478PubMedGoogle Scholar
  2. 2.
    Schaberg DR, Culver DH, Gaynes RP (1991) Major trends in the microbial etiology of nosocomial infection. Am J Med 91(3B):72S–75SCrossRefPubMedGoogle Scholar
  3. 3.
    Patterson JE, Sweeney AH, Simms M et al (1995) An analysis of 110 serious enterococcal infections. Epidemiology, antibiotic susceptibility, and outcome. Medicine (Baltimore) 74(4):191–200CrossRefGoogle Scholar
  4. 4.
    Bush LM, Calmon J, Cherney CL et al (1989) High-level penicillin resistance among isolates of enterococci. Implications for treatment of enterococcal infections. Ann Intern Med 110(7):515–520PubMedGoogle Scholar
  5. 5.
    Patterson JE, Zervos MJ (1990) High-level gentamicin resistance in Enterococcus: microbiology, genetic basis, and epidemiology. Rev Infect Dis 12(4):644–652PubMedGoogle Scholar
  6. 6.
    Rice LB (2001) Emergence of vancomycin-resistant enterococci. Emerg Infect Dis 7(2):183–187CrossRefPubMedGoogle Scholar
  7. 7.
    Raymond NJ, Blackmore TK, Humble MW et al (2006) Bloodstream infections in a secondary and tertiary care hospital setting. Intern Med J 36(12):765–772CrossRefPubMedGoogle Scholar
  8. 8.
    Li JS, Sexton DJ, Mick N et al (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30(4):633–638CrossRefPubMedGoogle Scholar
  9. 9.
    Caballero-Granado FJ, Becerril B, Cuberos L et al (2001) Attributable mortality rate and duration of hospital stay associated with enterococcal bacteremia. Clin Infect Dis 32(4):587–594CrossRefPubMedGoogle Scholar
  10. 10.
    The Australian Council on Healthcare Standards (ACHS) (2005) ACHS Clinical Indicator Users’ Manual, version 3. ACHS, SydneyGoogle Scholar
  11. 11.
    Ritchie S, Jowitt D, Roberts S; Auckland District Health Board Infection Control Service (2007) The Auckland City Hospital Device Point Prevalence Survey 2005: utilisation and infectious complications of intravascular and urinary devices. N Z Med J 120(1260):U2683PubMedGoogle Scholar
  12. 12.
    Poh CH, Oh HM, Tan AL (2006) Epidemiology and clinical outcome of enterococcal bacteraemia in an acute care hospital. J Infect 52(5):383–386CrossRefPubMedGoogle Scholar
  13. 13.
    The Grupo Andaluz para el estudio de las Enfermedades Infecciosas (1998) Comparative study of bacteremias caused by Enterococcus spp. with and without high-level resistance to gentamicin. J Clin Microbiol 36(2):520–525Google Scholar
  14. 14.
    Leavis HL, Bonten MJ, Willems RJ (2006) Identification of high-risk enterococcal clonal complexes: global dispersion and antibiotic resistance. Curr Opin Microbiol 9(5):454–460CrossRefPubMedGoogle Scholar
  15. 15.
    Bryan CS, Reynolds KL, Brown JJ (1985) Mortality associated with enterococcal bacteremia. Surg Gynecol Obstet 160(6):557–561PubMedGoogle Scholar
  16. 16.
    Edmond MB, Wallace SE, McClish DK et al (1999) Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 29(2):239–244CrossRefPubMedGoogle Scholar
  17. 17.
    Leclercq R, Derlot E, Duval J et al (1988) Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 319:157–161PubMedCrossRefGoogle Scholar
  18. 18.
    DiazGranados CA, Zimmer SM, Klein M et al (2005) Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 41(3):327–333CrossRefPubMedGoogle Scholar
  19. 19.
    Bhavnani SM, Drake JA, Forrest A et al (2000) A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia. Diagn Microbiol Infect Dis 36(3):145–158CrossRefPubMedGoogle Scholar
  20. 20.
    Environmental Science & Research (2007) Vancomycin-resistant enterococci (VRE) confirmed in 2006. Environmental Science & Research, Porirua, Wellington, New Zealand. Available online at: Accessed 13 April 2009
  21. 21.
    Environmental Science & Research (2008) Vancomycin-resistant enterococci (VRE) confirmed in 2007. Environmental Science & Research, Porirua, Wellington, New Zealand. Available online at: Accessed 13 April 2009
  22. 22.
    Shaked H, Carmeli Y, Schwartz D et al (2006) Enterococcal bacteraemia: epidemiological, microbiological, clinical and prognostic characteristics, and the impact of high level gentamicin resistance. Scand J Infect Dis 38(11–12):995–1000CrossRefPubMedGoogle Scholar
  23. 23.
    Antalek MD, Mylotte JM, Lesse AJ et al (1995) Clinical and molecular epidemiology of Enterococcus faecalis bacteraemia, with special reference to strains with high-level resistance to gentamicin. Clin Infect Dis 20(1):103–109PubMedGoogle Scholar
  24. 24.
    Watanakunakorn C, Patel R (1993) Comparison of patients with enterococcal bacteremia due to strains with and without high-level resistance to gentamicin. Clin Infect Dis 17(1):74–78PubMedGoogle Scholar
  25. 25.
    Gavaldà J, Len O, Miró JM et al (2007) Brief communication: treatment of Enterococcus faecalis endocarditis with ampicillin plus ceftriaxone. Ann Intern Med 146(8):574–579PubMedGoogle Scholar
  26. 26.
    Falagas ME, Matthaiou DK, Bliziotis IA (2006) The role of aminoglycosides in combination with a beta-lactam for the treatment of bacterial endocarditis: a meta-analysis of comparative trials. J Antimicrob Chemother 57(4):639–647CrossRefPubMedGoogle Scholar
  27. 27.
    Olaison L, Schadewitz K; Swedish Society of Infectious Diseases Quality Assurance Study Group for Endocarditis (2002) Enterococcal endocarditis in Sweden, 1995–1999: can shorter therapy with aminoglycosides be used? Clin Infect Dis 34(2):159–166CrossRefGoogle Scholar
  28. 28.
    Abbassi MS, Achour W, Hassen AB (2007) High-level gentamicin-resistant Enterococcus faecium strains isolated from bone marrow transplant patients: accumulation of antibiotic resistance genes, large plasmids and clonal strain dissemination. Int J Antimicrob Agents 29(6):658–664CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Microbiology DepartmentJohn Radcliffe HospitalOxfordUK
  2. 2.Middlemore HospitalAucklandNew Zealand
  3. 3.LabPlus, Auckland City HospitalAucklandNew Zealand

Personalised recommendations