{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T02:30:32Z","timestamp":1777429832731,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background:\u00a0Enterococcus faecium bloodstream infections (EF-BSI) cause significant morbidity and mortality in solid organ transplant (SOT) recipients, with the role of vancomycin resistance (VR) remaining controversial as an independent driver. Methods: This was a retrospective cohort study including SOT recipients with EF-BSI at our institution from 2019 to 2023. We used Cox proportional hazards regression to identify predictors of 30-day all-cause mortality. A time-dependent covariate was used to model the effects of receiving targeted, effective antibiotic therapy. Results: A total of 79 patients were included (26.6%, with VR). The overall 30-day mortality was 12.7% (10\/79). In univariable analysis, septic shock (Hazard Ratio, HR: 17.1, 95% CI: 3.64\u201380.8, p &lt; 0.001), the need for Continuous Venovenous Hemofiltration (HR: 6.40, 95% CI: 1.85\u201322.1, p = 0.003), and a Pitt Bacteremia Score \u2265 2 (HR: 5.17, 95%CI: 1.10\u201324.3, p = 0.038) were associated with increased mortality, while source control was protective (HR: 0.20, 95% CI: 0.05\u20130.76, p = 0.018). In the final multivariable model, only septic shock remained an independent predictor of 30-day mortality (HR: 11.4, 95% CI: 1.63\u201379.5, p = 0.014). VR was not significantly associated with mortality, though the confidence interval was wide and included clinically meaningful effects (HR: 2.07, 95% CI: 0.40\u201310.6, p = 0.4). Conclusions: In SOT recipients with EF-BSI, 30-day mortality is overwhelmingly driven by the host\u2019s physiological response, manifested as septic shock, rather than the VR profile of the pathogen. The early recognition of severe sepsis\/septic shock and the aggressive implementation of supportive care and source control measures in this setting are crucial.<\/jats:p>","DOI":"10.3390\/antibiotics15020119","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T11:14:07Z","timestamp":1769426047000},"page":"119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Vancomycin Resistance on 30-Day Mortality in Solid Organ Transplant Recipients with Enterococcus faecium Bloodstream Infections: A Retrospective Cohort Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0263-0703","authenticated-orcid":false,"given":"Maria","family":"Mazzitelli","sequence":"first","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy"},{"name":"Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7218-7762","authenticated-orcid":false,"given":"Alberto Enrico","family":"Maraolo","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples \u201cFederico II\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umberto","family":"Barbieri","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2911-2255","authenticated-orcid":false,"given":"Vincenzo","family":"Scaglione","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lolita","family":"Sasset","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2264-7986","authenticated-orcid":false,"given":"Lucrezia","family":"Furian","sequence":"additional","affiliation":[{"name":"Kidney and Pancreas Transplantation Unit, Department of Surgical Gastroenterological and Oncological Sciences, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2310-0245","authenticated-orcid":false,"given":"Umberto","family":"Cillo","sequence":"additional","affiliation":[{"name":"Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6261-699X","authenticated-orcid":false,"given":"Gino","family":"Gerosa","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Loy","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7855-5055","authenticated-orcid":false,"given":"Emanuele","family":"Cozzi","sequence":"additional","affiliation":[{"name":"Transplant Immunology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Hospital-Ospedale Giustinianeo, 35121 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8791-191X","authenticated-orcid":false,"given":"Patrizia","family":"Burra","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University of Padua, 35122 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8632-3465","authenticated-orcid":false,"given":"Federico","family":"Rea","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2869-2945","authenticated-orcid":false,"given":"Annamaria","family":"Cattelan","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e15285","DOI":"10.1111\/ctr.15285","article-title":"Epidemiology and outcomes associated with enterococcal blood stream infection among liver and kidney transplant recipients","volume":"38","author":"He","year":"2024","journal-title":"Clin. 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