Is Enterococcal Bacteremia a Cause or Corollary of Severe Illness? 5 Years’ Experience from an Indian Teaching Hospital

Background and aims: Enterococci have emerged as successful pathogens in healthcare-associated infections due to their hardiness and survival ability in environments with high background antimicrobial pressure. Enterococcal bacteremia (EB) present an intriguing link between the host, environmental and healthcare practices. We present here the detailed clinical epidemiology of EB from an Indian hospital. Patients and methods: We retrospectively studied adult patients diagnosed with bacteremia by Enterococcal species for 5 years. The details of clinical characteristics, implicated species, factors contributing to the development of bacteremia and the underlying source were analyzed. All the clinical and laboratory findings and antimicrobial therapy associated with clinical outcome were assessed. Results: Enterococcus faecium was the predominant pathogen in 82(42.5%) of the total 193 cases. Prior healthcare exposure was evident in 136(70.46%). Direct admission to intensive care during initial presentation was noted in 107(55.4%) of study cohort. Among 82(42.5%) of EB, source could be identified and central line infection was the commonest source in 45(23.3%). In-hospital mortality was 47, 23%, while 40(21%) left the hospital due to poor clinical outcome. Multivariate analysis indicated age >60 years, intra-abdominal disease as initial presentation, staying in the ICU during bacteremia, presence of central line and invasive mechanical ventilation as independent risk factors for fatality and poor clinical outcome. Conclusion: Enterococcal bacteremia can present both as cause and outcome of severe illness. Multiple comorbidities, healthcare acquisition, and limited therapy options suggest the need for strategies to prevent the invasive infections by enterococci.