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Outcomes Associated With Vancomycin‐Resistant Enterococci: A Meta‐Analysis
Formats Available in JSTOR: PDF
Abstract(back to top)
BACKGROUND. Because patients with vancomycin‐resistant Enterococcus bacteremia (VREB) usually have a higher severity of illness, it has been unclear whether VREB is worse than vancomycin‐susceptible Enterococcus bacteremia (VSEB).
METHODS. Data on morbidity and case fatality rates and costs were pooled from studies comparing VREB and VSEB, identified by Medline (January 1986 to April 2002) and meeting abstracts. Heterogeneity across studies was assessed with contingency table chi‐square. Multivariate analyses (MVAs) controlling for other predictors were evaluated.
RESULTS. Thirteen studies compared case‐fatality rates of VREB and VSEB. VREB case fatality was significantly higher (48.9% vs 19%; RR, 2.57; CI95, 2.27 to 2.91; attributable mortality = 30%). Five studies compared VREB with VSEB when bacteremia was the direct cause of death; VREB case fatality was significantly higher (39.1% vs 21.8%; RR, 1.79; CI95, 1.28 to 2.5; attributable mortality = 17%). Four MVAs found significant increases in case‐fatality rates (OR, 2.10 to 4.0), 3 showed trends toward increase (OR, 1.74 to 3.34 with wide confidence intervals), and 3 with low statistical power found no difference. VREB recurred in 16.9% versus 3.7% with VSEB (P < .0001). Three studies reported significant increases in LOS, costs, or both with VREB.
CONCLUSION. Most studies have had inadequate sample size, inadequate adjustment for other predictors of adverse outcomes, or both, but available data suggest that VREB is associated with higher recurrence, mortality, and excess costs than VSEB including multiple studies adjusting for severity of illness.
Bibliographic Information(back to top)
- Outcomes Associated With Vancomycin‐Resistant Enterococci: A Meta‐Analysis
- Cassandra D. Salgado , MD and Barry M. Farr , MD, MSc
- Infection Control and Hospital Epidemiology
- Vol. 24, No. 9 (September 2003) (pp. 690-698)
Notes and References(back to top)
This item contains 1 note(s).
Notes
Dr. Salgado is from the Brody School of Medicine, East Carolina University, Greenville, North Carolina. Dr. Farr is from the Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.Address reprint requests to Barry M. Farr, MD, MSc, P.O. Box 800473, University of Virginia Health System, Charlottesville, VA 22908.Presented at the 12th Annual Meeting of the Society for Healthcare Epidemiology of America; April 6‐9, 2002; Salt Lake City, UT.
Items Citing this Item (back to top)
10 item(s) in JSTOR cite this item
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