Enterococcal bacteraemia ‘silent but deadly’: a population‐based cohort study

Abstract Background The high mortality rate of patients with enterococcal infections has been shown to be associated with the severity of underlying comorbidities. Aims To characterise the epidemiology, clinical characteristics, outcomes and predictors of mortality in patients with enterococcal bacteraemia. Methods This was a retrospective cohort study of all enterococcal bacteraemia episodes in the Barwon region between January 2010 and March 2017. We assessed the epidemiology, clinical characteristics, outcomes and predictors of mortality using descriptive statistics and simple and multiple logistic regression analyses. Results The incidence of enterococcal bacteraemia was 19.9/100 000 person‐years. Males comprised 68.4%, and the median age was 71 years. Common comorbidities were gastrointestinal tract disease, urological disease, malignancies and cardiovascular disease. Infective endocarditis was observed in 15% of patients, and 1 of 27 also had colorectal cancer. Twelve patients referred for colonoscopy demonstrated previously undiagnosed colorectal neoplasia in 75% of these cases. The 30‐day and 1‐year mortality rates were 11.7 and 40.2% respectively. Sixty‐nine cases with vancomycin‐resistant Enterococcus were observed. Multiple logistic regression suggested that the presence of underlying urological malignancy (adjusted odds ratio = 3.57, 95% confidence intervals = 1.10–11.65, P = 0.035) and colorectal cancer (adjusted odds ratio = 4.47, 95% confidence intervals = 1.36–14.66, P = 0.014) were significant predictors of 1‐year mortality. Conclusions Microbiological cure was inversely associated with 30‐day mortality. The presence of underlying urological and colorectal malignancy was a predictor of 1‐year mortality. We identified the importance of evaluating patients with Enterococcus faecalis bacteraemia for underlying colorectal neoplasia. Routine colonoscopy is recommended in patients with E. faecalis bacteraemia or infective endocarditis with an unclear source of infection.