Enterococci commonly cause nosocomial bloodstream infections (BSIs), and the global
incidence of vancomycin-resistant enterococci (VRE) BSIs is rising. This study aimed to assess the
risk factors for enterococcal BSIs and 30-day mortality, stratified by Enterococcus species, vancomycin
resistance, and treatment appropriateness. We conducted a retrospective cohort study (2014–2021)
including all hospitalized adult patients with at least one blood culture positive for Enterococcus
faecalis or Enterococcus faecium. We included 584 patients with enterococcal BSI: 93 were attributed to
vancomycin-resistant E. faecium. The overall 30-day mortality was 27.5%; higher in cases of BSI due
to vancomycin-resistant E. faecium (36.6%) and vancomycin-sensitive E. faecium (31.8%) compared
to E. faecalis BSIs (23.2%) (p = 0.016). This result was confirmed by multivariable Cox analysis.
Independent predictors of increased mortality included the PITT score, complicated bacteremia, and
age (HR = 1.269, p < 0.001; HR = 1.818, p < 0.001; HR = 1.022, p = 0.005, respectively). Conversely,
male gender, consultation with infectious disease (ID) specialists, and appropriate treatment were
associated with reduced mortality (HR = 0.666, p = 0.014; HR = 0.504, p < 0.001; HR = 0.682, p = 0.026,
respectively). In conclusion, vancomycin-resistant E. faecium bacteremia is independently associated
with a higher risk of 30-day mortality.
