The purpose of this study is to determine risk factors associated with mortality in surgical patients with
vancomycin-resistant enterococcus (VRE)
infections. The hospitalizations of surgical patients with VRE
infections from January 1998 to December 2001 were reviewed. Statistical analysis was performed using the Student's t test, chi square, and Fisher's exact test. Thirty-one surgical patients (male:female, 14:17) with a mean age of 51.9 years (range, 21-83 years) developed VRE
infection.
Infections included
bacteremia (12), urinary tract (11), surgical site (seven), and soft tissue (five)
infections and
intra-abdominal abscess (one). Nine (29.0 per cent) patients received recent outpatient
antibiotics and 20 (64.5 per cent) were on
steroids. Fifteen (48.4 per cent) patients were treated with intravenous
vancomycin before
infection. Twelve (38.1 per cent) patients died with a trend toward advanced age (60.7 vs 46.5 years; P = 0.06). The incidence of VRE
infection in kidney transplant patients was 1.8 per cent. Six transplant patients (five kidney and one kidney/ pancreas) developed VRE
infections with four deaths.
Hypertension (P = 0.04),
coronary artery disease (P = 0.02), and the need for intra-arterial pressure monitoring (P = 0.04) were associated with mortality. Isolate location, gender, diabetes, renal dysfunction, respiratory
disease, liver disease, and
serum albumin were not associated with mortality. Kidney transplant patients have a high incidence of VRE
infection. Surgical patients with VRE
infections have a high mortality rate.
Hypertension and
coronary artery disease are risk factors for mortality.