International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Vancomycin-resistant Enterococcus infective endocarditis: A case series and review of the literature.
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Cairns Kelly A, Abbott Iain J, Udy Andrew A, Peel Trisha N, Spelman Denis W, Lee Sue J, Rawson-Harris Philip, Dooley Michael J, Peleg Anton Y
Аннотация
OBJECTIVES: To describe the epidemiology, management and clinical outcomes of patients with VRE infective endocarditis.
METHODS: We performed a retrospective review of VRE infective endocarditis cases from our institution and the published literature between 2000 and 2024. Predictors of mortality were assessed using univariate and multivariate logistic regression.
RESULTS: A total of 72 cases were identified (18 local and 54 from the literature) from nine countries. Median age was 60.0 years (IQR: 44.0-69.0), with 64.8% of cases being male. Enterococcus faecium was the most common species (64/72, 88.9%). Presence of a central venous catheter (25/72, 34.7%), requiring haemodialysis (19/72, 26.4%) and underlying diabetes (18/72, 25.0%) were the most commonly reported comorbidities associated with endocarditis. Native cardiac valves were most commonly affected (n = 47/72, 65.3%), with surgical intervention uncommon (21.2%). Nineteen patients (26.4%) were treated with monotherapy, with the remaining 53 patients receiving sequential therapy using 30 different antibiotic combinations. Median treatment duration was 50.0 days (IQR: 31.0-58.0) and the end-of-treatment mortality was 40.8% (n = 29/71). There were no independent predictors of mortality identified.
CONCLUSIONS: VRE endocarditis is an uncommon infection with high mortality. We highlight the diversity in antimicrobial management and importance of further research into this challenging infection.
METHODS: We performed a retrospective review of VRE infective endocarditis cases from our institution and the published literature between 2000 and 2024. Predictors of mortality were assessed using univariate and multivariate logistic regression.
RESULTS: A total of 72 cases were identified (18 local and 54 from the literature) from nine countries. Median age was 60.0 years (IQR: 44.0-69.0), with 64.8% of cases being male. Enterococcus faecium was the most common species (64/72, 88.9%). Presence of a central venous catheter (25/72, 34.7%), requiring haemodialysis (19/72, 26.4%) and underlying diabetes (18/72, 25.0%) were the most commonly reported comorbidities associated with endocarditis. Native cardiac valves were most commonly affected (n = 47/72, 65.3%), with surgical intervention uncommon (21.2%). Nineteen patients (26.4%) were treated with monotherapy, with the remaining 53 patients receiving sequential therapy using 30 different antibiotic combinations. Median treatment duration was 50.0 days (IQR: 31.0-58.0) and the end-of-treatment mortality was 40.8% (n = 29/71). There were no independent predictors of mortality identified.
CONCLUSIONS: VRE endocarditis is an uncommon infection with high mortality. We highlight the diversity in antimicrobial management and importance of further research into this challenging infection.