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Enterococcal bacteraemia: predictive and prognostic risk factors for ampicillin resistance
T Matsumura1, M Nagao1, S Nakano1
1Department of Clinical Laboratory Medicine,Kyoto University Graduate School of Medicine,54 Shogoin-Kawaharacho,Sakyo-ku,Kyoto 6068507,Japan.
Epidemiology and Infection
|September 1, 2018
Summary
Ampicillin-resistant enterococcal bacteraemia, particularly from E. faecium, is linked to hospital acquisition. Unknown sources and higher Pitt bacteraemia scores predict mortality in both E. faecalis and E. faecium infections.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Enterococcal bacteraemia is a significant nosocomial infection.
- Ampicillin resistance is a growing concern, especially in E. faecium.
- Understanding risk factors for ampicillin-resistant enterococcal bacteraemia is crucial for patient outcomes.
Purpose of the Study:
- To identify predictive factors for acquiring ampicillin-resistant enterococcal bacteraemia.
- To determine prognostic factors associated with 30-day mortality in enterococcal bacteraemia.
- To inform empirical treatment strategies for severe enterococcal infections.
Main Methods:
- Retrospective review of patient data from Kyoto University Hospital (2009-2015).
- Analysis of demographic, microbiological, and clinical data.
- Logistic regression for predictive factors and Cox regression for prognostic factors.
Main Results:
- Nosocomial acquisition was strongly associated with ampicillin-resistant E. faecium (OR 13.6).
- Bacteraemia from an unknown source and increased Pitt bacteraemia score (PBS) were significant predictors of 30-day mortality for both E. faecium (HR 2.91, 1.36) and E. faecalis (HR 4.17, 1.27).
- High rates of ampicillin resistance were observed in E. faecium (91.2%).
Conclusions:
- Hospital-acquired infections with ampicillin-resistant E. faecium require specific attention.
- Unknown source and elevated PBS are critical indicators for mortality risk in enterococcal bacteraemia.
- Empirical glycopeptide therapy is recommended for suspected severe E. faecium bacteraemia from unknown sources.
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