A risk-based assessment of Enterococcal Bloodstream infection: Suggesting considerations in empirical therapy strategies in a tertiary care hospital.

PURPOSE: Enterococcal bloodstream infections (E-BSIs) pose a significant challenge due to their unique intrinsic and increasing resistance. Empirical treatment guidelines are often ineffective in E-BSI, as Antibiotic policies mainly address Gram-negative bacilli and MRSA for Hospital-acquired infection (HAI) in India.

METHODS

The study was designed to investigate the risk factors, infection source, species profile, antimicrobial susceptibility and clinical outcomes in diagnosed E-BSI patients at a tertiary care centre in India. From the blood culture samples from August 2022 to July 2023, 52 non-duplicate blood culture isolates of Enterococcus species were identified with categorisation of vancomycin resistance genes, and the patients were followed up for risk factors, probable sources, and ongoing therapies, with a switch to definitive therapy for the outcome.

RESULTS

Of 52 confirmed E-BSI cases, the species distribution was as follows: E. faecium (61.5 %), E. faecalis (26.92 %), E. gallinarum (9.61 %), and E. durans (1.92 %). Antimicrobial resistance was significantly higher in E. faecium. Nine isolates (17.3 %) were vancomycin-resistant enterococci (VRE), with diverse outcomes. HAI comprised 44.23 % of cases. The overall mortality rate was 26.9 % and ICU patients had significantly higher mortality, with significant risk factors being invasive medical devices (59.6 %), followed by bedridden status (23 %) and immunosuppression (9.61 %). Significant risk factors included the presence of invasive medical devices (59.6 %), followed by a bedridden status (23.0 %) and immunosuppression (9.6 %). Patients with early empirical therapy that has enterococcal coverage showed a protective effect on survival. However, switching over to definitive therapy alone could not significantly reduce mortality.

CONCLUSION

This study underscores the importance of early empirical therapy with enterococcal coverage in high-risk patients. Timely initiation of empirical coverage appears more crucial than later definitive therapy adjustments in improving survival. Invasive device use remains a significant risk factor, reinforcing the need for stringent infection control to prevent HAI, including E-BSI.