The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

中文翻译：

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万古霉素耐药性会增加死亡率吗？粪肠球菌感染患者的临床结果和死亡率预测因素

肠球菌感染（尤其是粪肠球菌）的流行正在增加，而万古霉素耐药性对临床结局的影响问题也引起争议。这项研究旨在调查由粪肠球菌引起的感染的临床结果，并确定与死亡率相关的危险因素。这项回顾性研究于2014年至2018年期间在Phramongkutklao医院进行。招募了145例粪肠球菌感染的患者。耐万古霉素（VR）-粪肠球菌感染的患者与易受万古霉素（VS）-粪肠球菌感染的患者的30天和90天死亡率分别为57.7％，38.7％和69.2％与47.1％。VR-粪肠球菌感染患者的中位住院时间明显更长。在逻辑回归分析中，粪便中的VR-大肠杆菌，序贯器官衰竭评估（SOFA）评分以及骨骼和关节感染是与30天和90天死亡率相关的重要危险因素。此外，Cox比例风险模型显示粪便VR-大肠杆菌感染（HR 1.91； 95％CI 1.09–3.37）， SOFA得分为6–9分（HR 2.69； 95％CI 1.15–6.29），SOFA得分≥10分（HR 3.71; 95％CI 1.70–8.13）和骨和关节感染（HR 0.08; 95％CI 0.01–0.62）是导致死亡的重要危险因素。总之，本研究证实了VR-粪肠球菌感染对死亡率和住院时间的影响。因此，针对VR-粪肠球菌感染，特别是对于重症患者，合适的抗生素方案是改善治疗效果的有效策略。