Bactériémies à Enterococcus spp. : étude prospective au CHU de Nîmes

Abstract

Purpose of the study. – The aim of this study was the description of enterococcal bacteremia and the evaluation of their resistance evolution to antibiotics and the virulence profile of these isolates. Patients and methods. – We have studied all the bacteremia caused by Enterococcus spp. from the 1st of July 2003 until the 30th of June 2004 at Nîmes university hospital. For each isolate, population, clinical and microbiological data were collected. Multiplex PCR allowed for the identification of glycoprotein resistant phenotypes and furthermore, to identify the main virulence genes found in the enterococci. Results. – Thirty-three strains were identified from 33 patients (60.6% male) with a median age of 68 years (median: 3–96). The vital prognostic was calculated in 63.6% of the cases (MacCabe ≥ 1); seven patients died during their hospitalization (21.2%). The infections were nosocomial in 60.6% of the cases. No epidemic was observed. The principal comorbities were cardiovascular and digestive pathologies. In addition, 54.5% of patients had had a surgical intervention. Enterococus faecalis (87.9%) was the cause of infection in the majority of cases followed by Enterococus faecium. Most of the infections were monomicrobial (75.8%). E. faecalis was sensitive to amoxicilline and to glycopeptides but was resistant to norfloxacine, erythromycine and pristinamycine. The same observations were made for the E. faecium with the exception of amoxicillin. E. faecalis had the maximum number of virulence genes and E. faecium the least. Conclusion. – The enterococcal bacteremia had mainly a nosocomial origin. The isolates came from digestive tract flora but also from catheters. The mortality rate was 21.2%. A developing sensitivity to erythromycin and pristinamycine was observed in comparison to the data of the ONERBA (2002–2003). Only one isolate was resistant to glycopeptide. This was the first european E. faecium containing the vanD allele. This isolate proved fatal to the patient. The dark evolution of enterococcal bacteremia and their frequent nosocomial origin induce to promote studies intended for better knowing the risk factors of such infections.