1032. Are enterococcal blood stream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness? - The Munich Multi-Centric Enterococci cohort
Authors: Bachfischer Tobias , Wurst Milena , Karapetyan Siranush , Hapfelmeier Alexander , Schneider Jochen , Gleich Sabine , Dichtl Karl , Schmid Roland , Wagner Laura , Triebelhorn Julian , Erber Johanna , Seybold Ulrich , burgkart rainer , obermeier Andreas , Voit Floran , Busch Dirk , Rämer patrick , Spinner Christoph , Rothe kathrin 
Published: November 2023

Abstract

Background
To assess the long-term survival of patients with enterococcal bloodstream infections (BSI), encompassing various species and resistance patterns, in comparison to Escherichia coli (E. coli) BSI.
Recruitment process
Graphical Abstract

Methods
Between 2010 and 2019, 3,290 enterococcal and 3,415 E. coli BSI were retrospectively screened in seven hospitals in Munich, Germany. All vancomycin (VRE), vancomycin/linezolid (LVRE), and linezolid (LRE) resistant Enterococcus faecium (ECFM) BSI were included. Enterococcus faecalis (ECFA), vancomycin/Linezolid-susceptible ECFM, and E. coli BSI were randomly assigned. Cox-regression models were used to assess survival as the primary endpoint and were adjusted for limiting prognostic factors, which were measured for their importance using a random forest model (RFM).

Results
952 patients with 916 episodes of enterococcal BSI and 193 E. coli BSI episodes were analysed. RFM identified multimorbidity and markers for disease severity as most indicative of low survival in enterococcal BSI. The 5-year survival was significantly lower for enterococcal BSI than for E. coli BSI (23.9% vs. 42.3%; p&lt; 0.001). This difference remained significant in the Cox-regression analysis after adjusting for 17 prognostic factors and excluding patients with limited life expectancy (metastatic tumour disease, Charlson comorbidity index ≥5). Adjusted 5-year survival between E. coli and ECFA was similar but significantly different between ECFA and ECFM BSI (29.2% vs. 21.7%; p=0.002). The analysis conducted on monomicrobial ECFM and VRE BSI indicated that their respective 5-year survival was similar (19.6% vs. 21.2%; p=0.753).

Conclusion
ECFM BSI seems to be an independent risk factor for poor long-term survival. However, additional vancomycin resistance does not appear to be a contributing factor.

Disclosures
Jochen Schneider, MD, JS reports grants, personal fees, and nonfinancial support from AbbVie, Gilead Sciences, Janssen-Cilag, GSK/ViiV Healthcare, and MSD, Dr. Falk Pharma: Grant/Research Support Karl Dichtl, MD, KD reports grants from Euroimmun Medizinische Labordiagnostika and Fujifilm Wako Chemicals Europe outside of this study.: Advisor/Consultant Ulrich Seybold, MD, reports personal fees and nonfinancial support from Gilead Sciences, ViiV Healthcare, Janssen-Cilag, Falk Foundation, Sanofi-Aventis.: Advisor/Consultant Christoph Spinner, MD, AbbVie, Gilead Sciences, Janssen-C,MSD, Cepheid, GSK, ViiV Healthcare, AstraZeneca, Apeiron, Braun, Pfizer, Novartis, Lilly, Biontech…: Advisor/Consultant|AbbVie, Gilead Sciences, Janssen-C,MSD, Cepheid, GSK, ViiV Healthcare, AstraZeneca, Apeiron, Braun, Pfizer, Novartis, Lilly, Biontech…: Board Member|AbbVie, Gilead Sciences, Janssen-C,MSD, Cepheid, GSK, ViiV Healthcare, AstraZeneca, Apeiron, Braun, Pfizer, Novartis, Lilly, Biontech…: Grant/Research Support|CDS reports grants and personal fees from AbbVie, grants, fees and non-financial support from Gilead Sciences, grants and personal fees from Janssen-C: Advisor/Consultant|CDS reports grants and personal fees from AbbVie, grants, fees and non-financial support from Gilead Sciences, grants and personal fees from Janssen-C: Board Member|CDS reports grants and personal fees from AbbVie, grants, fees and non-financial support from Gilead Sciences, grants and personal fees from Janssen-C: Grant/Research Support