{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T11:45:23Z","timestamp":1774007123863,"version":"3.50.1"},"reference-count":30,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2023,12,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            To assess the long-term survival of patients with enterococcal bloodstream infections (BSI), encompassing various species and resistance patterns compared to\n            <jats:italic>Escherichia coli<\/jats:italic>\n            (\n            <jats:italic>E. coli<\/jats:italic>\n            ) BSI. Between 2010\u20132019, 3,290 enterococcal and 3,415\n            <jats:italic>E. coli<\/jats:italic>\n            BSI were retrospectively screened in seven hospitals in Munich, Germany. All vancomycin-resistant (VRE), vancomycin\/linezolid-resistant (LVRE), and linezolid-resistant (LRE)\n            <jats:italic>Enterococcus faecium<\/jats:italic>\n            (ECFM) BSI were included.\n            <jats:italic>Enterococcus faecalis<\/jats:italic>\n            (ECFA), vancomycin\/linezolid-susceptible ECFM, and\n            <jats:italic>E. coli<\/jats:italic>\n            BSI were randomly assigned. Cox regression analysis was used to assess survival as the primary endpoint and was adjusted for limiting prognostic factors, which were measured for their importance using a random forest model (RFM). We analyzed 952 patients with 916 episodes of enterococcal BSI and 193 episodes of\n            <jats:italic>E. coli<\/jats:italic>\n            BSI. 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\n            <jats:italic>E. coli<\/jats:italic>\n            BSI (23.9% vs 42.3%;\n            <jats:italic>P<\/jats:italic>\n            &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 tumor disease, Charlson-Comorbidity-Index \u22655). Adjusted 5-year survival was similar for\n            <jats:italic>E. coli<\/jats:italic>\n            and ECFA but significantly different between ECFA and ECFM (29.2% vs 21.7%;\n            <jats:italic>P<\/jats:italic>\n            = 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%;\n            <jats:italic>P<\/jats:italic>\n            = 0.753). 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.\n          <\/jats:p>\n          <jats:sec>\n            <jats:title>IMPORTANCE<\/jats:title>\n            <jats:p>\n              The present study provides a substantial contribution to literature, showing that patients with enterococcal bloodstream infections (BSI) have a lower survival rate than those with\n              <jats:italic>Escherichia coli<\/jats:italic>\n              (\n              <jats:italic>E. coli<\/jats:italic>\n              ) bloodstream infections after adjusting for 17 limiting prognostic factors and excluding patients with a limited life expectancy [metastatic tumor disease, Charlson Comorbidity Index (CCI) (greater than or equal to) 5]. This difference in the 5-year long-term survival was mainly driven by\n              <jats:italic>Enterococcus faecium<\/jats:italic>\n              (ECFM) bloodstream infections, with vancomycin resistance not being a significant contributing factor. Our findings imply that\n              <jats:italic>E. faecium<\/jats:italic>\n              bloodstream infections seem to be an independent risk factor for poor long-term outcomes. As such, future research should confirm this relationship and prioritize investigating its causality through prospective studies.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.02585-23","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T13:01:52Z","timestamp":1696424512000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":7,"title":["Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?\u2014The Munich multicentric enterococci cohort"],"prefix":"10.1128","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8293-5832","authenticated-orcid":false,"given":"Kathrin","family":"Rothe","sequence":"first","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Hygiene, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Bachfischer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siranush","family":"Karapetyan","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Health Services Research, University Hospital rechts der Isar, School of Medicine, Technical University of Munich , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Hapfelmeier","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Health Services Research, University Hospital rechts der Isar, School of Medicine, Technical University of Munich , Munich, Germany"},{"name":"Institute of AI and Informatics in Medicine, University Hospital rechts der Isar, School of Medicine, Technical University of Munich , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milena","family":"Wurst","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"Gleich","sequence":"additional","affiliation":[{"name":"Public Health Service , City of Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Dichtl","sequence":"additional","affiliation":[{"name":"Max von Pettenkofer-Institut f\u00fcr Hygiene und Medizinische Mikrobiologie, Medizinische Fakult\u00e4t, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen , Munich, Germany"},{"name":"Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz , Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland M.","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"},{"name":"German Centre for Infection Research (DZIF), partner site Munich , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Triebelhorn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"},{"name":"German Centre for Infection Research (DZIF), partner site Munich , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"},{"name":"German Centre for Infection Research (DZIF), partner site Munich , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Erber","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"},{"name":"German Centre for Infection Research (DZIF), partner site Munich , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Voit","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"},{"name":"German Centre for Infection Research (DZIF), partner site Munich , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rainer","family":"Burgkart","sequence":"additional","affiliation":[{"name":"Clinic of Orthopaedics and Sports Orthopaedics, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Obermeier","sequence":"additional","affiliation":[{"name":"Clinic of Orthopaedics and Sports Orthopaedics, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich","family":"Seibold","sequence":"additional","affiliation":[{"name":"German Centre for Infection Research (DZIF), partner site Munich , Munich, Germany"},{"name":"Division of Infectious Diseases, Department of Medicine IV, Hospital of the LMU Munich , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk H.","family":"Busch","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Hygiene, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"},{"name":"German Centre for Infection Research (DZIF), partner site Munich , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick C.","family":"R\u00e4mer","sequence":"additional","affiliation":[{"name":"Department of Hospital Hygiene and Infection Control, Munich Municipal Hospital Group , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph D.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine , Munich, Germany"},{"name":"German Centre for Infection Research 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