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Volume 15
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10.3390/antibiotics15020119
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Article

Impact of Vancomycin Resistance on 30-Day Mortality in Solid Organ Transplant Recipients with Enterococcus faecium Bloodstream Infections: A Retrospective Cohort Analysis

by
Maria Mazzitelli
1,2,3,*,†,
Alberto Enrico Maraolo
4,*,†,
Umberto Barbieri
1,
Vincenzo Scaglione
1,
Lolita Sasset
1,
Lucrezia Furian
5,
Umberto Cillo
6,
Gino Gerosa
7,
Monica Loy
8,
Emanuele Cozzi
9,
Patrizia Burra
10,
Federico Rea
11,‡ and
Annamaria Cattelan
1
1
Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
2
Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
3
Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
4
Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy
5
Kidney and Pancreas Transplantation Unit, Department of Surgical Gastroenterological and Oncological Sciences, Padua University Hospital, 35128 Padua, Italy
6
Hepatopancreatobiliary Surgery and Liver Transplantation, Padua University Hospital, 35128 Padua, Italy
7
Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
8
Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Padua University Hospital, 35128 Padua, Italy
9
Transplant Immunology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Hospital-Ospedale Giustinianeo, 35121 Padua, Italy
10
Department of Gastroenterology, University of Padua, 35122 Padua, Italy
11
Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
 
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*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
‡
Deceased.
Antibiotics 2026, 15(2), 119; https://doi.org/10.3390/antibiotics15020119
Submission received: 19 December 2025 / Revised: 18 January 2026 / Accepted: 21 January 2026 / Published: 26 January 2026
(This article belongs to the Special Issue Antimicrobial Resistance in the Community Setting: The Other Side of the Coin)
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Abstract

Background: Enterococcus 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: 3.64–80.8, p < 0.001), the need for Continuous Venovenous Hemofiltration (HR: 6.40, 95% CI: 1.85–22.1, p = 0.003), and a Pitt Bacteremia Score ≥ 2 (HR: 5.17, 95%CI: 1.10–24.3, p = 0.038) were associated with increased mortality, while source control was protective (HR: 0.20, 95% CI: 0.05–0.76, p = 0.018). In the final multivariable model, only septic shock remained an independent predictor of 30-day mortality (HR: 11.4, 95% CI: 1.63–79.5, 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: 0.40–10.6, p = 0.4). Conclusions: In SOT recipients with EF-BSI, 30-day mortality is overwhelmingly driven by the host’s 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.
Keywords: Enterococcus faecium; bacteraemia; bloodstream infections; mortality; predictors; solid organ transplant; transplant recipients Enterococcus faecium; bacteraemia; bloodstream infections; mortality; predictors; solid organ transplant; transplant recipients

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MDPI and ACS Style

Mazzitelli, M.; Maraolo, A.E.; Barbieri, U.; Scaglione, V.; Sasset, L.; Furian, L.; Cillo, U.; Gerosa, G.; Loy, M.; Cozzi, E.; et al. Impact of Vancomycin Resistance on 30-Day Mortality in Solid Organ Transplant Recipients with Enterococcus faecium Bloodstream Infections: A Retrospective Cohort Analysis. Antibiotics 2026, 15, 119. https://doi.org/10.3390/antibiotics15020119

AMA Style

Mazzitelli M, Maraolo AE, Barbieri U, Scaglione V, Sasset L, Furian L, Cillo U, Gerosa G, Loy M, Cozzi E, et al. Impact of Vancomycin Resistance on 30-Day Mortality in Solid Organ Transplant Recipients with Enterococcus faecium Bloodstream Infections: A Retrospective Cohort Analysis. Antibiotics. 2026; 15(2):119. https://doi.org/10.3390/antibiotics15020119

Chicago/Turabian Style

Mazzitelli, Maria, Alberto Enrico Maraolo, Umberto Barbieri, Vincenzo Scaglione, Lolita Sasset, Lucrezia Furian, Umberto Cillo, Gino Gerosa, Monica Loy, Emanuele Cozzi, and et al. 2026. "Impact of Vancomycin Resistance on 30-Day Mortality in Solid Organ Transplant Recipients with Enterococcus faecium Bloodstream Infections: A Retrospective Cohort Analysis" Antibiotics 15, no. 2: 119. https://doi.org/10.3390/antibiotics15020119

APA Style

Mazzitelli, M., Maraolo, A. E., Barbieri, U., Scaglione, V., Sasset, L., Furian, L., Cillo, U., Gerosa, G., Loy, M., Cozzi, E., Burra, P., Rea, F., & Cattelan, A. (2026). Impact of Vancomycin Resistance on 30-Day Mortality in Solid Organ Transplant Recipients with Enterococcus faecium Bloodstream Infections: A Retrospective Cohort Analysis. Antibiotics, 15(2), 119. https://doi.org/10.3390/antibiotics15020119

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