Abstract
Enterococcus spp bacteremia is associated with high mortality and the appearance of high-level gentamicin resistance (HLGR) created additional challenges for the treatment of these infections. We evaluated the epidemiological and clinical characteristics of patients with bacteremias caused by HLGR and non_HLGR Enterococcus faecalis isolates at a teaching hospital in the State of São Paulo, Brazil. Patients with bacteremia due to E. faecalis diagnosed between January 1999 and December 2003 were included in the study. We collected clinical, epidemiological, and microbiological data from medical records. Banked isolates were typed using pulsed-field gel electrophoresis. We identified 145 cases of E. faecalis bacteremia: 66 (45.5%) were caused by HLGR isolates and 79 (54.5%) by non_HLGR. In the univariate analysis, patients with HLGR infection were older, had higher rates of bladder catheterization, and more often had treatment with cephalosporin, quinolone, and/or carbapenem compared with patients with non_HLGR infection (P < 0.05). Multivariate analysis indicated that older age, hematological malignancy, and previous use of vancomycin were independently associated with HLGR (P < 0.05). Mortality rates were not significantly different among patients with HLGR (50%) and non_HLGR (43%) infections (P = 0.40). Of the 32 genotyped isolates, 16 were distributed into 6 main electrophoresis patterns and 16 others had distinct patterns. E. faecalis bacteremia is associated with high mortality and is frequently caused by HLGR isolates at this teaching hospital. The variability among genotyped isolates suggests that endogenous infections, rather than patient-to-patient transmission of E. faecalis, are more common at this institution.
Highlights
Enterococcus spp is the third most frequent cause of hospital-acquired bacteremia, accounting for 8% of all nosocomial bacteremias in the United States [1]
Enterococcal bacteremia is associated with high mortality, which is even further increased when caused by Highlevel gentamicin resistance (HLGR) strains compared with those caused by non–HLGR strains [3,4,5]
Since Enterococcus spp is the second most common cause of Gram-positive blood stream infections in Brazil and that approximately 76% of all enterococcal infections are due to Enterococcus faecalis, we evaluated cases of bacteremia caused by this organism at the teaching hospital of the Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo State [8]
Summary
Enterococcus spp is the third most frequent cause of hospital-acquired bacteremia, accounting for 8% of all nosocomial bacteremias in the United States [1]. Since Enterococcus spp is the second most common cause of Gram-positive blood stream infections in Brazil and that approximately 76% of all enterococcal infections are due to Enterococcus faecalis, we evaluated cases of bacteremia caused by this organism at the teaching hospital of the Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo State [8]. Our objective was to characterize the epidemiological, clinical, and microbiological features of bacteremias caused by HLGR and non– HLGR E. faecalis isolated from January 1999 through December 2003. This evaluation could help identify measures to reduce the frequency of these infections, especially when caused by HLGR bacteria
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