Clinical manifestations, characteristics, and outcome of infections caused by vancomycin-resistant enterococci at a tertiary care center in Lebanon: A case-case-control study

Background: Vancomycin-resistant enterococci (VRE) are prevalent infectious agents that particularly affect critically-ill patients, and they are on the rise in Lebanon. We aim at determining the potential risk factors and complications for VRE and vancomycin-susceptible enterococci (VSE) infections in a hospital setting and identify risk factors for in-hospital mortality.Methods: A case-case-control study design was used where patients with VRE and VSE were included as two separate groups and each group was compared to uninfected controls. We also constructed binary regression models to detect risk factors that were associated with the acquisition of a VRE or a VSE in-fection. We also identified independent mortality predictors for all patients with enterococcal infection as well as patients with only a VRE infection.Results: A total of 142 patients with enterococcal infections (VRE and VSE) were compared to 142 in -pa-tients not infected with Enterococcus spp. independent risk factors for a VRE infection were steroid therapy within 30 days and the presence of another infection preceding the VRE infection (aOR 15.4, 95 % CI 2.4-99.3 and 23.9, 95 % CI 3.9-1482, respectively). An independent risk factor for VSE was diabetes mellitus (aOR 5.4, 95 % CI 1.1-26.6). Based on these risk factors, we developed a risk score to be used in quantifying the risk of VRE in a patient with an enterococcal infection. Male sex and low albumin were significant risk factors for mortality in our patient cohort.Conclusions: VRE and VSE infections have distinct risk factors that can be used to guide empiric anti-microbial therapy.(c) 2023 The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/li-censes/by-nc-nd/4.0/).

Automated summary

This study aims to identify potential risk factors, complications, and mortality predictors for vancomycin-resistant enterococci (VRE) and vancomycin-susceptible enterococci (VSE) infections in a hospital setting. The results showed that patients with diabetes mellitus were more susceptible to VSE infection, while patients who received steroid therapy within 30 days and had a preceding infection were more susceptible to VRE infection.