Increase in Bloodstream Infection Due to Vancomycin-Susceptible <i>Enterococcus faecium</i> in Cancer Patients: Risk Factors, Molecular Epidemiology and Outcomes

<div><p>We conducted a prospective study to assess the risk factors, molecular epidemiology and outcome of bloodstream infection (BSI) due to <i>Enterococcus faecium</i> in hospitalized cancer patients. Between 2006 and 2012, a significant increase in vancomycin-susceptible <i>E. faecium</i> BSI was observed among cancer patients. Comparison of 54 episodes of BSI due to <i>E. faecium</i> with 38 episodes of BSI due to <i>E. faecalis</i> showed that previous use of carbapenems was the only independent risk factor for <i>E. faecium</i> acquisition (OR 10.24; 95% CI, 1.35-77.66). All <i>E. faecium</i> isolates were susceptible to glycopeptides, whereas 97% showed high-level resistance to ampicillin and ciprofloxacin. All 30 isolates available for genotyping belonged to the hospital-associated <i>E. faecium</i> lineages 17, 18 and 78. After 2009, most of the isolates belonged to ST117 (lineage 78). Patients with <i>E. faecium</i> BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with <i>E. faecalis</i> BSI, and time to adequate empirical antibiotic therapy was also longer in the former group. No significant differences were found between the two groups regarding early and overall case-fatality rates. Independent risk factors for overall case-fatality were current corticosteroids (OR 4.18; 95% CI, 1.34-13.01) and intensive care unit admission (OR 9.97; 95% CI, 1.96-50.63). The emergence of <i>E. faecium</i> among cancer patients is a concern since there are limited treatment options and it may presage the emergence of vancomycin-resistant enterococci. A rationale approach that combines infection control with antimicrobial stewardship.</p> </div>