German A ContrerasMUNITA SEPULVEDA, JOSE MANUELJOSE MANUELMUNITA SEPULVEDAShelby SimarCourtney LuterbachAn Q DinhKirsten RydellPranoti V SahasrabhojaneRafael RiosLorena DiazKatherine ReyesMarcus ZervosHelina M MisikirGabriela Sanchez-PetittoCatherine LiuYohei DoiLilian M AbboLuis ShimoseHarald SeifertCarlota GudiolFernanda BarberisClaudia PedrozaSamuel L AitkenSamuel A ShelburneDavid van DuinTruc T TranBlake M HansonCesar A Arias2023-01-092023-01-092021Contreras, G. A., Munita, J. M., Simar, S., Luterbach, C., Dinh, A. Q., Rydell, K., Sahasrabhojane, P. V., Rios, R., Diaz, L., Reyes, K., Zervos, M., Misikir, H. M., Sanchez-Petitto, G., Liu, C., Doi, Y., Abbo, L. M., Shimose, L., Seifert, H., Gudiol, C., … Arias, C. A. (2022). Contemporary clinical and molecular epidemiology of vancomycin-resistant enterococcal bacteremia: A prospective multicenter cohort study(Venous i). Open Forum Infectious Diseases, 9(3), ofab616. https://doi.org/10.1093/ofid/ofab616https://repositorio.udd.cl/handle/11447/5845https://investigadores.udd.cl/handle/123456789/507510.1093/ofid/ofab6162-s2.0-85124911342WOS:000753585300001<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Vancomycin-resistant enterococci (VRE) are major therapeutic challenges. Prospective contemporary data characterizing the clinical and molecular epidemiology of VRE bloodstream infections (BSIs) are lacking.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The Vancomycin-Resistant Enterococcal BSI Outcomes Study (VENOUS I) is a prospective observational cohort of adult patients with enterococcal BSI in 11 US hospitals. We included patients with Enterococcus faecalis or Enterococcus faecium BSI with ≥1 follow-up blood culture(s) within 7 days and availability of isolate(s) for further characterization. The primary study outcome was in-hospital mortality. Secondary outcomes were mortality at days 4, 7, 10, 12, and 15 after index blood culture. A desirability of outcome ranking was constructed to assess the association of vancomycin resistance with outcomes. All index isolates were subjected to whole genome sequencing.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Forty-two of 232 (18%) patients died in hospital and 39 (17%) exhibited microbiological failure (lack of clearance in the first 4 days). Neutropenia (hazard ratio [HR], 3.13), microbiological failure (HR, 2.4), VRE BSI (HR, 2.13), use of urinary catheter (HR, 1.85), and Pitt BSI score ≥2 (HR, 1.83) were significant predictors of in-hospital mortality. Microbiological failure was the strongest predictor of in-hospital mortality in patients with E faecium bacteremia (HR, 5.03). The impact of vancomycin resistance on mortality in our cohort changed throughout the course of hospitalization. Enterococcus faecalis sequence type 6 was a predominant multidrug-resistant lineage, whereas a heterogeneous genomic population of E faecium was identified.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Failure of early eradication of VRE from the bloodstream is a major factor associated with poor outcomes.</jats:p> </jats:sec>Resource Types::text::journal::journal article