Risk factors for vancomycin resistance in patients with bloodstream infections: an analysis of the Munich Multicentric Enterococci Cohort.

Unlabelled: is difficult to treat owing to its intrinsic and acquired resistance to antibiotics, particularly vancomycin. Vancomycin-resistant is an important cause of bloodstream infections in healthcare settings with limited treatment options. This study aimed to analyze the risk factors for vancomycin-resistant bloodstream infection. This retrospective analysis of data from the Munich Multicentric Enterococci Cohort analyzed 200 episodes of nonrecurrent vancomycin-susceptible bloodstream infection and 196 episodes of nonrecurrent vancomycin-resistant bloodstream infection from six hospitals in Munich, Germany, between 2010 and 2019. Logistic regression was used to identify risk factors for vancomycin-resistant bloodstream infection. In the unadjusted analysis, the risk factors for vancomycin-resistant bloodstream infection included the length of hospital stay, previous treatment with vancomycin or linezolid, and solid organ transplantation. In the multivariable analysis, prior treatment with vancomycin and solid organ transplantation were independent risk factors for vancomycin-resistant bloodstream infection. Vancomycin resistance was not significantly associated with the severity of underlying diseases. This study identified prior vancomycin treatment and solid organ transplantation as key independent risk factors for vancomycin-resistant bloodstream infection.

Importance: Vancomycin-resistant is a growing threat in healthcare settings, challenging the management of enterococcal infections. This study identified prior treatment with vancomycin and solid organ transplantation as risk factors for vancomycin-resistant bloodstream infections. Based on the analysis of five disease severity scores for acute and chronic illness, the severity of underlying diseases could not be demonstrated to be a risk factor for the occurrence of vancomycin resistance in bloodstream infections.