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Bacteremia caused by hemolytic, high-level gentamicin-resistant Enterococcus faecalis.

M M Huycke1, C A Spiegel, M S Gilmore

  • 1Department of Medicine, University of Wisconsin, Madison 53706.

Antimicrobial Agents and Chemotherapy
|August 1, 1991
PubMed
Summary

High-level gentamicin resistance in Enterococcus faecalis is often linked to hemolysin production. This combination increases the risk of death in bacteremia patients.

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Area of Science:

  • Microbiology
  • Infectious Diseases
  • Molecular Biology

Background:

  • Enterococcal blood isolates are a significant cause of hospital-acquired infections.
  • High-level aminoglycoside resistance (HLAR) in enterococci complicates treatment options.
  • Hemolysin production in enterococci has been associated with virulence.

Purpose of the Study:

  • To investigate the prevalence of high-level gentamicin resistance (HLAR) and hemolysin production in Enterococcus faecalis blood isolates.
  • To determine the association between HLAR, hemolysin production, and specific genetic markers.
  • To identify risk factors for and clinical outcomes of HLAR E. faecalis bacteremia.

Main Methods:

  • Analysis of 206 enterococcal blood isolates for HLAR and hemolysin production.

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  • Detection of the gene encoding the AAC(6 egular)-APH(2") enzyme in resistant strains.
  • DNA restriction endonuclease digestion patterns to assess strain relatedness.
  • Historical cohort study using regression analysis to identify risk factors and clinical outcomes.

    • Main Results:

    • 35.8% of E. faecalis isolates exhibited HLAR to gentamicin, with 98.5% possessing the AAC(6 egular)-APH(2") enzyme gene.
    • 44.7% of isolates were hemolytic, carrying the enterococcal hemolysin gene.
    • A significant association was found between gentamicin resistance and hemolysin production (91.2% vs. 18.8%, P < 0.001).
    • Hemolytic, gentamicin-resistant strains showed evidence of common derivation.
    • Postsurgical ICU status and broad-spectrum cephalosporin use were risk factors for gentamicin-resistant E. faecalis bacteremia.
    • Patients with hemolytic, gentamicin-resistant bacteremia had a fivefold increased risk of death.

    Conclusions:

    • High-level gentamicin resistance in E. faecalis is strongly associated with hemolysin production and a specific enzyme.
    • Certain clinical factors, including ICU stay and prior antibiotic exposure, increase the risk of developing gentamicin-resistant E. faecalis bacteremia.
    • Co-occurrence of high-level gentamicin resistance and hemolysin production in E. faecalis is a significant predictor of poor patient outcomes.