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Enterococcal bacteremia: analysis of 75 episodes
R M Gullberg1, S R Homann, J P Phair
1Section of Infectious Disease, Northwestern University Medical School, Chicago, Illinois 60611.
Abstract:
Seventy-five cases of enterococcal bacteremia were analyzed retrospectively. Most patients had serious underlying disease and blood cultures became positive on an average of 27 days after admission. Polymicrobial bacteremia occurred in one-third of the patients. Twenty-two (30%) of the patients died during hospitalization; nine of these deaths were directly due to enterococcal bacteremia. Metastatic infections occurred in seven patients, including five with endocarditis. More than 40% of the patients were receiving antibiotic therapy at the time of bacteremia; cephalosporins were being administered to 56% of these. Thirty-eight patients were treated with two antibiotics. The commonest regimen was ampicillin and gentamicin; 90% of these patients responded. Eighteen patients were treated with only one antibiotic; 89% of these patients responded. Nineteen patients received no antibiotic therapy; the majority of these patients responded despite lack of therapy. Two-drug regimens are not always required for the treatment of enterococcal bacteremia, and treatment must be tailored to the particular clinical situation.
Insights
Enterococcal bacteremia, often occurring in seriously ill patients, shows high survival rates even without antibiotics. Treatment for enterococcal infections should be individualized, as two-drug regimens are not always necessary.
Area of Science:
- Infectious Diseases
- Internal Medicine
- Clinical Microbiology
Background:
- Enterococcal bacteremia is a significant cause of hospital-acquired infections.
- Patients often present with severe underlying conditions, complicating treatment and prognosis.
- The emergence of antibiotic resistance necessitates a re-evaluation of treatment strategies.
Purpose of the Study:
- To retrospectively analyze the clinical characteristics and outcomes of enterococcal bacteremia.
- To evaluate the effectiveness of different antibiotic treatment regimens.
- To determine factors influencing mortality and treatment response in patients with enterococcal bacteremia.
Main Methods:
- Retrospective analysis of 75 cases of enterococcal bacteremia.
- Review of patient demographics, underlying diseases, and clinical course.
- Assessment of antibiotic therapies, including single-drug, two-drug, and no-therapy groups.
Main Results:
- Most patients had serious underlying diseases, with bacteremia developing late after admission.
- Mortality was 30%, with 12% of deaths directly attributed to enterococcal bacteremia.
- High response rates were observed across all treatment groups, including those receiving no antibiotics, suggesting tailored therapy is effective.
Conclusions:
- Enterococcal bacteremia outcomes can be favorable, even in complex cases.
- Aggressive multi-drug therapy is not consistently superior and individualized treatment plans are crucial.
- Further research into optimal, tailored treatment strategies for enterococcal bacteremia is warranted.