Clinical Characteristics And Risk Factors In Mixed-Enterococcal Bloodstream Infections

Cheng Zheng,1,2,* Jiachang Cai,3,* Haizhou Liu,1,4,* Shufang Zhang,5 Li Zhong,1,6 Nanxia Xuan,1 Hongwei Zhou,3 Kai Zhang,1 Yesong Wang,1 Xijiang Zhang,2 Baoping Tian,1 Zhaocai Zhang,1 Changming Wang,2 Wei Cui,1 Gensheng Zhang1 1Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People’s Republic of China; 2Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, People’s Republic of China; 3Clinical Microbiology Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People’s Republic of China; 4Department of Critical Care Medicine, Zhejiang Rehabilitation Hospital, Hangzhou, Zhejiang, People’s Republic of China; 5Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, People’s Republic of China; 6Department of Critical Care Medicine, Huzhou First People’s Hospital, Huzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Gensheng ZhangDepartment of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People’s Republic of ChinaTel +86-571-8778-3636Fax +86-571- 87022776Email genshengzhang@zju.edu.cnPurpose: Although the enterococcal bloodstream infections (EBSI) are often observed in clinic, the mixed-EBSI are few reported. The aim of this study was to investigate the clinical characteristics and risk factors of mixed-EBSI in comparison with monomicrobial EBSI (mono-EBSI).Methods: A single-center retrospective observational study was performed between Jan 1, 2013 and Dec 31, 2018 in a tertiary hospital. All patients with EBSI were enrolled, and their data were collected by reviewing electronic medical records.Results: A total of 451 patients with EBSI were enrolled including 157 cases (34.8%) with mixed-EBSI. The most common co-pathogens were Coagulase-negative Staphylococcus (26.86%), followed by Acinetobacter baumannii (23.43%) and Klebsiella pneumoniae (8.57%). In multivariable analysis, burn injury (adjusted odds ratio [aOR], 7.39; 95% confidence interval [CI], 2.69–20.28), and length of prior hospital stay (aOR, 1.01; 95% CI, 1.00–1.02) were associated with mixed-EBSI. Patients with mixed-EBSI developed with more proportion of septic shock (19% vs. 31.8%, p=0.002), prolonged length of intensive care unit (ICU) stay [9(0,25) vs. 15(2.5,36), p