Vancomycin-Resistant Enterococcus-Positive Blood Cultures: Results From a Province-Wide Multisite Case Series Analysis in Ontario, Canada, January 2009-December 2013
Bibliographic record
Abstract
Background. Since 2009, all Ontario hospitals are mandated to report vancomycin-resistant Enterococcus (VRE)-positive (+) blood cultures to a provincial public reporting database. The objective of this study was to better understand the clinical characteristics, microbiology and outcomes of patients with VRE+ blood cultures in Ontario, Canada. Methods. A chart review of all cases reported by Ontario hospitals between January 2009 and December 2013 was performed by the Institute for Clinical and Evaluative Sciences using a standardized clinical data abstraction tool. False positives, incomplete or duplicate cases, as well as cases with a missing or invalid health card number were excluded from the analysis. Descriptive statistics were generated using SAS. Results. In total, 311 VRE+ blood cultures were reported. After exclusions, the final study sample was n = 232. Mean age was 61 years (range 1–97 years), 60% were male and 91% had at least one comorbidity, including: renal disease (34%), diabetes (28%), hematological malignancy (23%), non-hematological malignancy (11%) and transplant (solid organ [9%] and bone marrow [3%]); 42% were immunocompromised during their admission prior to their confirmed VRE+ blood culture and over half of patients (55%) were known to be VRE colonized. At the time of blood culture draw, 84% had a central line and 18% were neutropenic. Most VRE+ blood cultures (93%) were due to E. faecium. Although 72% were given empiric antibiotics at the time of blood culture draw, only 17% of patients received effective empiric anti-VRE therapy (linezolid 14%, daptomycin 3%). Overall, 74% of patients with VRE+ blood cultures received effective anti-VRE therapy; not receiving effective anti-VRE therapy was associated with an increased risk of death within 7 days (OR = 4.5; 95% CI, 2.3–9.0). In total, 48% of patients died during their hospitalization. A review of death certificates found that 1% of deaths indicated VRE infection as the primary cause of death. Conclusion. Most VRE+ blood cultures occurred in immunocompromised patients with invasive devices; nearly half of patients died during their hospital admission. Lack of effective anti-VRE therapy was associated with a significantly increased risk of death. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".