Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients.

PURPOSE: To analyze the impact of primary and catheterrelated bloodstream infections (PBSI/CRBSI) on morbidity and mortality. METHODS: A matched case-control study (1:4) was carried out on a Spanish epidemiological database of critically ill patients (ENVIN-HELICS). To determine the risk of death in patients with PBSI/CRBSI a matched Cox proportional hazard regression analysis was performed. RESULTS: Out of the 74,585 registered patients, those with at least one episode of monomicrobial PBSI/CRBSI were selected and paired with patients without PBSI/CRBSI for demographic and diagnostic criteria and seriousness of their condition on admission to the Intensive Care Unit (ICU). for mortality analysis, 1,879 patients with PBSI/CRBSI were paired with 7,516 controls. The crude death rate in the ICU was 28.1% among the cases and 18.7% among the controls. Attributable mortality 9.4% (HR:1.20; 95% confidence interval: 1.07-1.34; p<0.001). Risk of death varied according to the source of infection, aetiology, moment of onset of bloodstream infection and severity on admission to the ICU. The median stay in the ICU of patients who survived PBSI/CRBSI was 13 days longer than the controls, also varying according to aetiology, moment of onset of bloodstream infection and severity on admission. CONCLUSIONS: Acquisition of PBSI/CRBSI in critically ill patients significantly increases mortality and length of ICU stay, which justifies prevention efforts.

Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients

Objetivos. El propósito de este estudio es analizar el impacto de la bacteriemia primaria y relacionada con catéter (BP/ BRC) en la morbilidad y mortalidad. Métodos. Con datos pertenecientes a la base de datos epidemiológica de pacientes críticos en España ENVIN-HELICS, se realiza un estudio casos controles (1:4). Para analizar el riesgo de muerte en pacientes con BP/BRC se realiza un estudio emparejado de riesgos proporcionales de Cox. Resultados. De 74.585 pacientes registrados, se buscó pacientes con al menos un episodio de BP/BRC monomicrobiana y fueron emparejados con pacientes sin BP/BRC por criterios demográficos, diagnósticos y de gravedad al ingreso en la Unidad de Cuidados Intensivos (UCI). Para el análisis de mortalidad 1.879 pacientes con BP/BRC fueron emparejados con 7.516 controles. La mortalidad cruda en UCI fue del 28,1 % en los casos y 18,7 % en los controles. Mortalidad atribuida 9,4 %. (HR:1,20; intervalo confianza 95 %: 1,07 - 1,34; p<0,001). El riesgo de muerte varía de acuerdo a la fuente de la infección, la etiología, el momento de aparición de la bacteriemia y la gravedad al ingreso en UCI. Los pacientes que sobreviven y sufren una BP/BRC tienen una estancia en UCI 13 días de mediana más prolongada que los controles, variando también según la etiología, el momento de aparición de la bacteriemia y la gravedad al ingreso en UCI. Conclusiones. En pacientes críticos, la adquisición de una BP/BRC produce un significativo incremento de la mortalidad y la estancia, lo que justifica los esfuerzos de prevención(AU)

Purpose. To analyze the impact of primary and catheterrelated bloodstream infections (PBSI/CRBSI) on morbidity and mortality. Methods. A matched case-control study (1:4) was carried out on a Spanish epidemiological database of critically ill patients (ENVIN-HELICS). To determine the risk of death in patients with PBSI/CRBSI a matched Cox proportional hazard regression analysis was performed. Results. Out of the 74,585 registered patients, those with at least one episode of monomicrobial PBSI/CRBSI were selected and paired with patients without PBSI/CRBSI for demographic and diagnostic criteria and seriousness of their condition on admission to the Intensive Care Unit (ICU). For mortality analysis, 1,879 patients with PBSI/CRBSI were paired with 7,516 controls. The crude death rate in the ICU was 28.1% among the cases and 18.7% among the controls. Attributable mortality 9.4% (HR:1.20; 95% confidence interval: 1.07-1.34; p<0.001). Risk of death varied according to the source of infection, aetiology, moment of onset of bloodstream infection and severity on admission to the ICU. The median stay in the ICU of patients who survived PBSI/CRBSI was 13 days longer than the controls, also varying according to aetiology, moment of onset of bloodstream infection and severity on admission. Conclusions. Acquisition of PBSI/CRBSI in critically ill patients significantly increases mortality and length of ICU stay, which justifies prevention efforts(AU)

Survival of hematological patients after discharge from the intensive care unit: a prospective observational study.

INTRODUCTION: Although the survival rates of hematological patients admitted to the ICU are improving, little is known about the long-term outcome. Our objective was to identify factors related to long-term outcome in hematological patients after ICU discharge. METHODS: A prospective, observational study was carried out in seven centers in Spain. From an initial sample of 161 hematological patients admitted to one of the participating ICUs during the study period, 62 were discharged alive and followed for a median time of 23 (1 to 54) months. Univariate and multivariate analysis were performed to identify the factors related to long term-survival. Finally, variables that influence the continuation of the scheduled therapy for the hematological disease were studied. RESULTS: Mortality after ICU discharge was 61%, with a median survival of 18 (1 to 54) months. In the multivariate analysis, an Eastern Cooperative Oncology Group score (ECOG) >2 at ICU discharge (Hazard ratio 11.15 (4.626 to 26.872)), relapse of the hematological disease (Hazard ratio 9.738 (3.804 to 24.93)) and discontinuation of the planned treatment for the hematological disease (Hazard ratio 4.349 (1.286 to 14.705)) were independently related to mortality. Absence of stem cell transplantation, high ECOG and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores decreased the probability of receiving the planned therapy for the hematological malignancy. CONCLUSIONS: Both ICU care and post-ICU management determine the long-term outcome of hematological patients who are discharged alive from the ICU.

Pandemic and post-pandemic influenza A (H1N1) infection in critically ill patients.

BACKGROUND: There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described. METHODS: A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period. RESULTS: Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. CONCLUSION: Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection.

[Staphylococcus aureus nosocomial infections in critically ill patients admitted in intensive care units]. / Infecciones nosocomiales por Staphylococcus aureus en pacientes críticos en unidades de cuidados intensivos.

BACKGROUND AND OBJECTIVE: To investigate the frequency of nosocomial infections caused by Staphylococcus aureus in critically ill patients admitted to Spanish intensive care units (ICUs) and to describe the characteristics and outcome of patients in whom this pathogen was isolated. PATIENTS AND METHOD: Prospective, observational, and multicenter study. All patients admitted during one or 2 months to the participating ICUs in the National Nosocomial Infection Surveillance Study (ENVIN) between 1997 and 2003 were included. Patients were classified as infected by S. aureus, infected by other microorganisms, and without nosocomial infection. RESULTS: A total of 34,914 patients were controlled of whom 3,450 (9.9%) had acquired a nosocomial infection during his/her ICU stay (16.0 infections per 100 patients). In 682 (19.8%) patients, a total of 775 infectious episodes in which one of the microorganisms isolated was S. aureus were documented (cumulative incidence 2.2 episodes of S. aureus infection per 100 patients). There was a predominance of S. aureus infection in patients with pneumonia associated with mechanical ventilation (21.4%) and in patients with catheter-related bacteremia (13%). Independent variables associated with S. aureus infection were male sex (odds ratio [OR] = 1.25; 95% confidence interval [CI], 1.03-1.52) and underlying trauma pathology (OR = 1.72, 95%; 95%CI, 1.26-2.35), whereas an older age has been a protective factor (OR = 0.90; 95%CI, 0.84-0.96). Mortality in patients with S. aureus infection was significantly higher than in infections caused by other microorganisms, and in both cases higher than in patients without infection (34.5%, 30.3%, and 10.7%, respectively). In 208 (30.5%) patients, infections due to methicillin-resistant S. aureus were diagnosed, which in turn had increased significantly over the years (p = 0.001). Mortality in patients with methicillin-resistant S. aureus infection was 35.1% compared with 34.2% in patients with methicillin sensitive S. aureus infections (p = NS). CONCLUSIONS: S. aureus was isolated in 19.8% of patients with ICU-acquired infection, particularly in relation to pneumonia in mechanically ventilated patients. Mortality in patients with S. aureus infection was higher than that in patients with infections due to other microorganisms and patients without infection. In contrast, differences in the outcome of patients with infections caused by methicillin-sensitive or methicillin-resistant S. aureus were not found.

Infecciones nosocomiales por Staphylococcus aureus en pacientes críticos en unidades de cuidados intensivos / Staphylococcus aureus nosocomial infections in critically ill patients admitted in intensive care units

Fundamento y objetivo: Investigar la frecuencia de infecciones nosocomiales por Staphylococcus aureus en pacientes críticos ingresados en unidades de cuidados intensivos (UCI) de España y describir las características y la evolución de aquellos en quienes se han aislado. Pacientes y método: Se ha realizado un estudio prospectivo, observacional y multicéntrico, en el que se ha incluido a los pacientes ingresados en las UCI de los hospitales participantes en el Estudio Nacional de Vigilancia de Infección Nosocomial (ENVIN) durante 1 o 2 meses desde el año 1997 hasta 2003. Los pacientes se clasificaron como infectados por S. aureus, infectados por otros microorganismos y sin infecciones nosocomiales. Resultados: De 34.914 pacientes controlados 3.450 (9,9%) adquirieron 5.599 infecciones nosocomiales durante su estancia en la UCI (16,0 infecciones por cada 100 pacientes). En 682 (19,8%) de los pacientes con infecciones se identificaron 775 infecciones en las que uno de los microorganismos responsables era S. aureus (incidencia acumulada: 2,2 episodios de infección por S. aureus por 100 pacientes). Se observó un predominio de S. aureus en las neumonías relacionadas con ventilación mecánica (21,4%) y en las bacteriemias relacionadas con catéteres (13,0%). Las variables que se asociaron de forma individual con la aparición de infección por S. aureus fueron el sexo masculino (odds ratio [OR] = 1,25; intervalo de confianza [IC] del 95%, 1,03-1,52) y los procesos de base traumática (OR = 1,72; IC del 95%, 1,26-2,35), mientras que la mayor edad fue un factor protector (OR = 0,90; IC del 95%, 0,84-0,96). La mortalidad de los pacientes con infección por S. aureus fue significativamente superior a la de los pacientes con infecciones por otros microorganismos y, a su vez, la de ambas fue superior a la de los pacientes sin infecciones (el 34,5, el 30,3 y el 10,7%, respectivamente). En 208 (30,5%) pacientes las infecciones fueron debidas a S. aureus resistentes a meticilina, las cuales aumentaron de forma significativa a lo largo de los años analizados (p = 0,001). La mortalidad de los pacientes con infecciones producidas por S. aureus resistente a meticilina fue del 35,1%, y la de las producidas por S. aureus sensibles a meticilina del 34,2% (p = NS). Conclusiones: S. aureus está presente en el 19,8% de los pacientes con infecciones adquiridas en las UCI, principalmente en neumonías relacionadas con ventilación mecánica. La mortalidad de los pacientes con infecciones por S. aureus ha sido superior a la de los pacientes con infecciones por otros microorganismos y a la de pacientes sin infecciones. Por el contrario, no se han identificado diferencias en la evolución de los pacientes con infecciones por S. aureus sensibles o resistentes a meticilina

Background and objective: To investigate the frequency of nosocomial infections caused by Staphylococcus aureus in critically ill patients admitted to Spanish intensive care units (ICUs) and to describe the characteristics and outcome of patients in whom this pathogen was isolated. Patients and method: Prospective, observational, and multicenter study. All patients admitted during one or 2 months to the participating ICUs in the National Nosocomial Infection Surveillance Study (ENVIN) between 1997 and 2003 were included. Patients were classified as infected by S. aureus, infected by other microorganisms, and without nosocomial infection. Results: A total of 34,914 patients were controlled of whom 3,450 (9.9%) had acquired a nosocomial infection during his/her ICU stay (16.0 infections per 100 patients). In 682 (19.8%) patients, a total of 775 infectious episodes in which one of the microorganisms isolated was S. aureus were documented (cumulative incidence 2.2 episodes of S. aureus infection per 100 patients). There was a predominance of S. aureus infection in patients with pneumonia associated with mechanical ventilation (21.4%) and in patients with catheter-related bacteremia (13%). Independent variables associated with S. aureus infection were male sex (odds ratio [OR] = 1.25; 95% confidence interval [CI], 1.03-1.52) and underlying trauma pathology (OR = 1.72, 95%; 95%CI, 1.26-2.35), whereas an older age has been a protective factor (OR = 0.90; 95%CI, 0.84-0.96). Mortality in patients with S. aureus infection was significantly higher than in infections caused by other microorganisms, and in both cases higher than in patients without infection (34.5%, 30.3%, and 10.7%, respectively). In 208 (30.5%) patients, infections due to methicillin-resistant S. aureus were diagnosed, which in turn had increased significantly over the years (p = 0.001). Mortality in patients with methicillin-resistant S. aureus infection was 35.1% compared with 34.2% in patients with methicillin sensitive S. aureus infections (p = NS). Conclusions: S. aureus was isolated in 19.8% of patients with ICU-acquired infection, particularly in relation to pneumonia in mechanically ventilated patients. Mortality in patients with S. aureus infection was higher than that in patients with infections due to other microorganisms and patients without infection. In contrast, differences in the outcome of patients with infections caused by methicillin-sensitive or methicillin-resistant S. aureus were not found

[Infections caused by Acinetobacter spp. in critically ill ICU patients]. / Infecciones por Acinetobacter spp. en pacientes críticos en UCI.

INTRODUCTION: To determine the frequency of infections caused by Acinetobacter spp. in critically ill patients admitted to Spanish intensive care units (ICUs) and to assess the clinical features and outcome. PATIENTS AND METHOD: Prospective, observational, multicenter study. Patients admitted for one or two months to ICUs participating in the Spanish Nosocomial Surveillance Study (ENVIN project) between 1997 and 2003 were included. Patients were classified into the following groups: infected by Acinetobacter spp., infected by other pathogens, and uninfected. RESULTS: In 343 (9.9%) patients from among 3,450 with nosocomial infection, Acinetobacter spp. was one of the pathogens identified in 406 episodes (cumulative incidence, 1.2 episodes per 100 patients). A. baumannii was the predominant species in 357 cases (87.9%). Variables significantly associated with selection of Acinetobacter spp. were medical (OR: 2.47; 95% CI: 1.24-4.91) or traumatic underlying disease (OR: 4.40; 95% CI: 2.20-8.80) and ICU stay (OR: 1.03; 95% CI: 1.02-1.04). The overall mortality rate in ICU patients with infection (31.1%) was similar to that of patients with Acinetobacter spp. infections (31.5%), although in both cases it was significantly higher than mortality in uninfected patients (10.7%). ICU mortality rates in patients with imipenem-resistant and imipenem-sensitive Acinetobacter spp. infections were not significantly different (33.3% vs. 30.0%; p = 0.7283). CONCLUSIONS: Acinetobacter spp. were present in 9.9% of patients with ICU-acquired infection. There were no significant differences in ICU mortality rates between patients with Acinetobacter spp. infection and patients with infections caused by other microorganisms.

Infecciones por Acinetobacter spp. en pacientes críticos en UCI* / Infections caused by Acinetobacter spp. in critically ill ICU patients

Introducción. El objetivo del estudio fue investigar la frecuencia de infecciones por Acinetobacter spp. en pacientes críticos y describir sus características y evolución. Pacientes y método. Estudio prospectivo, observacional y multicéntrico. Se incluyó a los pacientes ingresados en la unidad de cuidados intensivos (UCI) participantes en el Estudio Nacional de Vigilancia de Infección Nosocomial (ENVIN) desde 1997 hasta 2003. Los pacientes se clasificaron como infectados por Acinetobacter spp., infectados por otros microorganismos y sin infecciones nosocomiales. Resultados. En 343 pacientes (9,9%) de los 3.450 que adquirieron infecciones nosocomiales se identificaron 406 infecciones, en las que uno de los microorganismos fue un Acinetobacter spp. (incidencia acumulada: 1,2 episodios por 100 pacientes). La especie predominante fue A. baumannii en 357 casos (87,9%). Las variables que influyeron significativamente en la selección de Acinetobacter spp. fueron la enfermedad de base médica (odds ratio [OR]: 2,47; intervalo de confianza del 95 % [IC 95%]: 1,24-4,91) o traumática (OR: 4,40; IC 95%: 2,20-8,80) y la estancia en la UCI (OR: 1,03; IC 95%: 1,02-1,04). No hubo diferencias en la mortalidad global intra-UCI entre los pacientes con infecciones por Acinetobacter spp. (31,5%) o infecciones por otros microorganismos (31,1%), aunque en ambos casos fue superior, de forma significativa, a la de pacientes sin infecciones (10,7%). No se detectaron diferencias en la mortalidad intra-UCI entre los pacientes con infecciones por Acinetobacter spp. resistente a imipenem (IMP) y sensible (33,3 % frente a 30,0%; p 5 0,7283). Conclusiones. Acinetobacter spp. está presente en el 9,9% de los pacientes con infecciones adquiridas en UCI. No se han detectado diferencias en la mortalidad intra-UCI entre los pacientes con infecciones por Acinetobacter spp. o infecciones producidas por otros microorganismos (AU)

Introduction. To determine the frequency of infections caused by Acinetobacter spp. in critically ill patients admitted to Spanish intensive care units (ICUs) and to assess the clinical features and outcome. Patients and method. Prospective, observational, multicenter study. Patients admitted for one or two months to ICUs participating in the Spanish Nosocomial Surveillance Study (ENVIN project) between 1997 and 2003 were included. Patients were classified into the following groups: infected by Acinetobacter spp., infected by other pathogens, and uninfected.Results. In 343 (9.9%) patients from among 3,450 with nosocomial infection, Acinetobacter spp. was one of the pathogens identified in 406 episodes (cumulative incidence, 1.2 episodes per 100 patients). A. baumannii was the predominant species in 357 cases (87.9%). Variables significantly associated with selection of Acinetobacter spp. were medical (OR: 2.47; 95% CI: 1.24-4.91) or traumatic underlying disease (OR: 4.40; 95% CI: 2.20-8.80) and ICU stay (OR: 1.03; 95% CI: 1.02-1.04). The overall mortality rate in ICU patients with infection (31.1%) was similar to that of patients with Acinetobacter spp. infections (31.5%), although in both cases it was significantly higher than mortality in uninfected patients (10.7%). ICU mortality rates in patients with imipenem-resistant and imipenem-sensitive Acinetobacter spp. infections were not significantly different (33.3% vs. 30.0%; p 5 0.7283). Conclusions. Acinetobacter spp. were present in 9.9% of patients with ICU-acquired infection. There were no significant differences in ICU mortality rates between patients with Acinetobacter spp. infection and patients with infections caused by other microorganisms (AU)

[Enterococcal infections in critically ill patients admitted to ICU]. / Infección por enterococo en pacientes críticos ingresados en la UCI.

BACKGROUND AND OBJECTIVE: To determine the frequency of infections caused by Enterococcus spp. in critically ill patients admitted to ICUs in Spain and to describe the clinical features and outcome of those patients in whom this pathogen was isolated. PATIENTS AND METHOD: Prospective, observational, multicenter study. Patients admitted to the ICUs who participated in the National Surveillance Study of Nosocomial Infections (ENVIN) from 1997 to 2001 were included. Patients were classified as infected by Enterococcus spp., infected by other pathogens, and without nosocomial infection (non-infected). RESULTS: Of 21,972 patients, 2,177 (9.9%) had acquired 3,490 nosocomial infections during their stay in the ICU. In 223 patients (10.2%), 239 episodes of infections in which one of the causative pathogen was Enterococcus spp. were identified (cumulative incidence 1.1 episodes of Enterococcus spp. infection per 100 patients). Enterococcus spp. accounted for urinary infection in 14.3% of cases and secondary bacteremia in 12.2% especially those related with abdominal infection (20%) and soft tissue infection (21.4%). Predominant species was E. faecalis in 197 isolates (82.4%). After multivariate analysis, variables significantly associated with infection caused by Enterococcus spp. included: age (odds ratio [OR]=1.13; 95% confidence interval [CI], 1.01-1.25); APACHE II score (OR=1.19; CI 95%, 1.07-1.32); and length of ICU stay (OR=1.02; CI 95%, 1.01-1.03). There were no differences in the overall ICU mortality rate between patients with Enterococcus spp. infection (31.8%) and those with infection caused by other pathogens (31.8%), although in both cases the mortality rate was significantly higher than in non-infected patients (11.1%). CONCLUSIONS: Enterococcus spp. was present in 10.2% patients with ICU-acquired infection. Infection by Enterococcus spp. mainly occurred in the form of urinary tract infection and secondary bacteremia, mainly related to abdominal and soft tissue infections. E. faecalis predominated in all foci. There were no differences in mortality between patients with Enterococcus spp. infection and patients with infection caused by other pathogens.

Infección por enterococo en pacientes críticosingresados en la UCI / Enterococcal infections in critically ill patients admitted to ICU

FUNDAMENTO Y OBJETIVO: Investigar la frecuencia de infecciones por Enterococcus spp. en pacientes críticos, ingresados en unidades de cuidados intensivos (UCI) de España y describir las características y evolución de los pacientes en los que se ha aislado este microorganismo.PACIENTES Y MÉTODO: Estudio prospectivo, observacional y multicéntrico. Se ha incluido a los pacientes ingresados en las UCI participantes en el Estudio Nacional de Vigilancia de Infección Nosocomial (ENVIN) desde el año 1997 hasta el 2001. Los pacientes se clasificaron como infectados por Enterococcus spp., infectados por otros microorganismos y sin infecciones nosocomiales.RESULTADOS: Se ha controlado a 21.972 pacientes de los que 2.177 (9,9 por ciento) han adquirido 3.490 infecciones nosocomiales durante su estancia en la UCI. En 223 (10,2 por ciento) de estos pacientes se han identificado 239 infecciones en las que uno de los microorganismos fue Enterococcus spp. (1,1 episodios de infección por Enterococcus spp. por 100 pacientes), predominando en infecciones urinarias (14,3 por ciento) y en las bacteriemias secundarias (12,2 por ciento) en especial en las originadas en una infección abdominal o de partes blandas. La especie más frecuente ha sido E. faecalis, con 197 aislamientos (82,4 por ciento). Los factores de riesgo independiente para desarrollar una infección por Enterococcus spp.han sido: edad (odds ratio [OR] = 1,13; intervalo de confianza [IC] del 95 por ciento, 1,01-1,25), índice APACHE II (OR = 1,19; IC del 95 por ciento, 1,07-1,32) y estancia en UCI (OR = 1,02; IC del 95 por ciento, 1,01-1,03).No se han identificado diferencias en la mortalidad global intra-UCI entre los pacientes con infecciones por Enterococcus spp. (31,8 por ciento) o por otros microorganismos (31,8 por ciento), aunque en ambos casos ha sido muy superior, de forma significativa, a la de los pacientes sin infecciones (11,1 por ciento). CONCLUSIONES: Enterococcus spp. está presente en el 10,2 por ciento de los pacientes con infecciones adquiridas en la UCI. Se localiza principalmente en infecciones urinarias y en bacteriemias secundarias, originadas en una infección abdominal o de partes blandas. No existen diferencias en la mortalidad de los pacientes con infecciones por Enterococcus spp. respecto a las infecciones producidas por otros microorganismos. (AU)